Full Digital Rehabilitation of a Complex Partially Edentulous Patient via Toronto Prosthesis: A Case Report

Abstract

This case report describes the oral rehabilitation of a complex partially edentulous patient with malpositioned teeth and implants using a full digital workflow and hybrid prosthesis design. A 55-year-old male patient presented with pain, oral hygiene, aesthetic, and functional complaints. Following extraction of teeth 26, 27, and 47, five endosseous dental implants were placed in regions 24, 26, 36, 46, and 47. Due to advanced hard and soft tissue loss and the patient's refusal of additional augmentation, implants in the 24–27 region were placed in a buccal-apical malposition despite guided tissue regeneration. After osseointegration, full-arch fixed partial dentures (FPDs) were planned for both jaws. Intraoral scanning, CBCT data, and pre/postoperative photographic records were integrated into the digital design workflow. Tooth-supported FPDs were designed as monolithic restorations; mandibular implant-supported FPDs (ISFPDs) as screw-retained monolithic; and maxillary ISFPDs as a hybrid Toronto Bridge design comprising a screw-retained zirconia substructure with a cement-retained monolithic superstructure. All restorations were fabricated from hybrid-composition multilayer monolithic zirconia blocks (3–5Y-PSZ) via CAD/CAM subtractive manufacturing. Try-in temporary restorations were evaluated for marginal fit, occlusion, and esthetics prior to final delivery. Digital workflow applications integrating intraoral scanning and photographic guidance are effective for achieving predictable aesthetic and functional outcomes in complex rehabilitations with malpositioned implants. The Toronto Bridge hybrid design successfully compensates for implant malposition, and hybrid-composition multilayer monolithic zirconia provides clinically reliable esthetic and mechanical results.

Keywords

• Digital workflow
• Hybrid retained restoration
• Partial edentulism
• Toronto bridge.

Malpoze Dişler ve İmplantlar İçeren Kompleks Parsiyel Dişsiz Bir Vakanın Toronto Tasarımlı Protez ve Tam Dijital İş Akışı ile Oral Rehabilitasyonu: Bir Vaka Sunumu

Abstract

Bu vaka sunumu, malpoze dişlere ve implantlara sahip kompleks parsiyel dişsiz bir hastanın tam dijital iş akışı ve hibrit protez tasarımı kullanılarak oral rehabilitasyonunu tanımlamaktadır. Elli beş yaşında erkek hasta ağrı, ağız hijyeni, estetik ve fonksiyonel şikayetlerle kliniğimize başvurdu. 26, 27 ve 47 numaralı dişlerin çekiminin ardından 24, 27, 36, 46 ve 47 numaralı bölgelere dört adet endoosseöz dental implant yerleştirildi. İleri düzey sert ve yumuşak doku kaybı ile hastanın ek ogmentasyon prosedürlerini reddetmesi nedeniyle, ileri cerrahi rejenaratif cerrahi uygulamalarına karşın 24–27 bölgesindeki implantlar bukkal-apikal yönde malpoze olarak yerleştirildi. Osseointegrasyon sonrasında her iki çene için tam ark sabit parsiyel protez (SPP) planlandı. Ağız içi tarama, KIBT verileri ile ameliyat öncesi ve sonrası fotoğrafik kayıtlar dijital tasarım iş akışına entegre edildi. Diş destekli SPP'ler monolitik restorasyon olarak; alt çene implant destekli sabit parsiyel protezler (İDSPP) vida tutuculu monolitik olarak; üst çene İDSPP'ler ise vida tutuculu zirkonya altyapı ile siman tutuculu monolitik üst yapıdan oluşan hibrit Toronto Köprü tasarımı olarak planlandı. Tüm restorasyonlar, CAD/CAM eksiltmeli üretim yöntemiyle hibrit kompozisyonlu çok katmanlı monolitik zirkonya bloklardan (3–5Y-PSZ) üretildi. Geçici try-in restorasyonlar, nihai teslimat öncesinde marjinal uyum, oklüzyon ve estetik açısından değerlendirildi. Ağız içi tarama ve fotoğrafik rehberliği entegre eden dijital iş akışı uygulamaları, malpoze implantlar içeren kompleks rehabilitasyonlarda öngörülebilir estetik ve fonksiyonel sonuçların elde edilmesinde etkilidir. Toronto Köprü hibrit tasarımı implant malpoze durumunu başarıyla telafi etmekte; hibrit kompozisyonlu çok katmanlı monolitik zirkonya ise klinik açıdan güvenilir estetik ve mekanik sonuçlar sunmaktadır.

Keywords

• Dijital iş akışı
• Hibrit destekli restorasyon
• Parsiyel dişsizlik
• Toronto köprü.

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