Fully Digital and Guided Full-Arch Dentistry by Drs. Jarron Tawzer and Joshua Nagao

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Categories: Implant Dentistry;
Fully Digital and Guided Full-Arch Dentistry 

by Drs. Jarron Tawzer and Joshua Nagao

Technology is evolving faster today than ever before, and dentistry is no exception. Embracing, understanding, and incorporating digital advancements can make outcomes more predictable and reliable while reducing time, stress, and uncertainty for both clinicians and patients. Often, doctors state that they struggle to get accurate records, achieve predictable results, spend countless appointments and chairside hours, and find full-arch cases “not worth” doing because of the complexities that can arise. It’s important to note that predictable, desired outcomes aren’t always achieved on the first attempt. However, understanding the process and implementing proper protocols and technology can greatly reduce stress and failures in these cases.

The following case demonstrates how multiple aspects of digital dentistry can work together to deliver efficient, accurate, and reproducible results.

Disclaimer: Full-arch dentistry requires advanced training and experience beyond the scope of this article. Proper education, mentorship, and clinical experience are not only recommended but essential when performing these procedures. Numerous training facilities and courses throughout the country can help clinicians develop the knowledge and skills required for full-arch implant therapy.
Fully Digital and Guided Full-Arch Dentistry
Fig. 1: Initial full-face photo
Fully Digital and Guided Full-Arch Dentistry
Fig. 2: Initial smile photo


Materials used
Implants: Megagen AnyRidge
Multi-Unit Abutments (MUA): Megagen AnyRidge (angled and straight)
Prosthetic screws: Vortex
Dental laboratory: JB Dental
Surgical guide: Implant Depot
Biologics: DIT-USA
Digital IO scanner/Photogrammetry: Trios 5/Micronmapper
Occlusal analysis: T-Scan
3D printer/resin: Sprintray 55s


Patient information
Age: 68-year-old male
ASA classification: ASA I (healthy patient with no systemic disease)

This article will show how the implementation of accurate record-taking, digital design and planning, and proper surgical technique can predictably lead to consistent results when performing full-arch surgical procedures. The record process for the patient included full volume CBCT and intraoral radiographs, clinical photos, and digital intraoral scans. A full medical history was reviewed to clear the patient for surgery.

Once the records were compiled, they were imported into design software that allowed merging of the intraoral scans with the CBCT, giving the practitioner the ability to accurately plan from both a prosthetic and surgical viewpoint. From these merged records, the case was planned for implant placement in optimal zones, paying close attention to bone availability, prosthetic span length, and maximizing anterior-posterior spread. Using these planning points will minimize the risk of fractures in the temporary and final prosthetics regardless of material selection. This allows the clinician to later select the most appropriate material for the final restoration without having to eliminate materials because of fracture risk. Based on the decision to complete this case as an FP3 restoration, the bone reduction was digitally completed to eliminate the possibility of a visible transition line when the patient smiles. Stackable guides were then designed based on the implant placement and bone reduction. These guides were designed in a way that allowed the fixation of the base to be inserted before extraction of the teeth, ensuring proper and accurate placement. The sequence of guide insertion was planned as follows: first, placement of the tooth-supported guide for base fixation; second, extraction of the teeth; third, connection of the bone reduction plate; and lastly, placement of the implant osteotomy guide.
Fully Digital and Guided Full-Arch Dentistry
Fig. 3: Stackable guides designed based on the implant placement and bone reduction.
Fully Digital and Guided Full-Arch Dentistry
Fig. 4: Individual components of the stackable guide system.

On the day of surgery, the patient was anesthetized (both IV sedation and local anesthesia) and prepared under sterile conditions. Markers were placed on the palate to facilitate merging of later scans. A full-thickness mucoperiosteal flap was reflected to expose the alveolar ridge. Once the extent of the flap was verified to allow placement of the guide without impingement, the tooth-supported guide was placed. Fixation pins were placed in the base guide, and the portion of the guide that was supported by the teeth was removed. Remaining teeth were extracted, and the surgical site was debrided. The bone reduction guide was then seated directly onto the guide base. Alveoloplasty was then performed to reduce the bone to the level established during the digital plan, creating the appropriate restorative space. After completion of the bone reduction, the alveoloplasty guide was removed while maintaining the fixation pins and base in place.

The implant surgical guide was then placed onto the guide base, and seating was confirmed. Guided osteotomies were performed sequentially according to the drilling protocol. Following preparation of the osteotomy sites, implants were placed in the predetermined positions, achieving appropriate primary stability. Multi-unit abutments were subsequently placed onto the implants to correct angulation and establish the restorative platform, and they were torqued according to the manufacturer’s recommended values. Photogrammetry was completed using the Micron Mapper as digital verification, and intraoral scans were taken with scan markers on the MUAs. This same process was repeated for the lower arch.

Once surgery was completed, all scan data was transmitted to the lab for digital design of temporary prostheses. The tooth position, bite, and aesthetics had been predetermined and approved in the planning stage. The designs were then printed using a Sprintray 55s 3D printer utilizing OnX Tough 2 as the material choice. Finishing and polishing were completed, and the gingival areas were characterized. The temporary prostheses were delivered using Vortex screws, and the bite was verified both visually and with the aid of the T-scan occlusal analysis device. Panoramic radiographs were taken to confirm implant and temporary prosthesis positioning.

The patient was given four months for complete healing and osseointegration. The patient was then appointed for Stage 2 records, which included a new photo series, intraoral scans of the existing temporary prostheses in the mouth, and tissue scans of the gingiva with the temporaries removed. Photogrammetry was repeated after reapplying the manufacturer’s torque recommendations to the MUAs. Final shade was selected with both the patient and his wife present.

The patient returned roughly three weeks later for final prosthetic delivery. Both the upper and lower prosthetics had great passive insertion and fit. Finals were torqued to the recommended value. Access holes were covered with a barrier (plumbing tape) and filled with composite that was finished with a high-polish cup. Occlusion was verified both manually and using the T-scan to verify proper force and excursive movement.

This patient was elated and emotional at the reveal of his final prosthetics. This case demonstrates how proper planning, case selection, the use of appropriate technology, and a well-conceived treatment plan can help achieve predictable, excellent results for both the doctor and the patient.
Fully Digital and Guided Full-Arch Dentistry
Fig. 5: Digital mock-up design of planned implants done before day of surgery.
Fully Digital and Guided Full-Arch Dentistry
Fig. 6: Six-week tissue post-op check.
Fully Digital and Guided Full-Arch Dentistry
Fig. 7: Six-week pano with 3D printed temporary prosthetics.
Fully Digital and Guided Full-Arch Dentistry
Fig. 8: Final full-face photo.
Fully Digital and Guided Full-Arch Dentistry
Fig. 9: Dr. Jarron Tawzer with patient at the final prosthetic reveal.
Author Bio
Dr. Jarron Tawzer Dr. Jarron Tawzer earned his undergraduate degree from Utah State University and graduated from Oregon Health and Science University School of Dentistry. He lives and practices in Logan, Utah, focusing on implants and cosmetic dentistry. Tawzer mentors at the Implant Pathway dental implant center in Phoenix, training dentists in complicated atraumatic extractions, bone grafting, and dental implants. He has dedicated much of his career to advancements in dentistry, particularly dental implants and cosmetic dentistry.
Dr. Joshua Nagao Dr. Joshua Nagao earned his DDS from The Ohio State University School of Dentistry, graduating first in his class clinically. Nagao is particularly passionate about dental surgery, including implant placements, sedation dentistry, and complex reconstructions. He is a faculty member and mentor at Implant Pathway, an associate fellow in the American Academy of Implant Dentistry, and a diplomate in the American Board of Oral Implantology. Nagao is also the creator of #implantsanta, a social media page dedicated to digital dental surgery and high-quality photography.
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