All-on-6 Upper Jaw Implant Rehabilitation with Early Loading in 72 Hours

The management of advanced periodontal disease culminating in total maxillary tooth loss represents one of the most demanding rehabilitative challenges in contemporary implant dentistry. The convergence of surgical complexity, prosthetic precision, and patient-driven expectations for rapid aesthetic recovery demands a workflow that is simultaneously fast, accurate, and reproducible. The emergence of high-speed ceramic-reinforced resin 3D printing — exemplified by the Shining3D Aoralscan Elite Intraoral Photogrammetry Scanner and AccuFab-F1 Dental Printer— has fundamentally altered the clinical timeline for full-arch implant restorations, enabling delivery of a definitive screw-retained prosthesis within 72 hours of surgical implant placement. 

1. Case Profile 

The patient, a 50-year-old male active smoker with no reported systemic diseases, presented with functional deficits and significant aesthetic concerns due to generalized chronic periodontitis and advanced bone loss in the maxillary arch. He strongly refused conventional removable prosthetics. Following a thorough initial periodontal treatment phase, a definitive full-arch implant rehabilitation was planned for the primary upper jaw (maxilla), with a staged treatment for the lower jaw post-adaptation. The selected treatment protocol involves full-arch screw-retained prostheses with early implant loading scheduled at 3 days post-surgery, fully aligning with the patient's aesthetic and functional preferences.

2. Treatment Objectives 

•  Complete Maxillary Rehabilitation

  Restore full masticatory function and aesthetics with a fixed, implant-supported prosthesis on six implants, eliminating any reliance on removable prosthetics. 

• Minimize Prosthetic Turnaround Time

  Deliver an early-loaded prosthesis within 72 hours of surgery by leveraging the high-speed printing capability of the AccuFab-F1, minimizing the edentulous period post-extraction. 

• Achieve Biomechanically Sound Implant Distribution

  Utilize angulated and pterygoid distal implants to maximize anchorage in available bone volume, compensating for the advanced resorption associated with chronic periodontitis. 

• Fully Digital, Reproducible Protocol

  Execute the entire workflow — from planning through printing — within a closed digital chain to ensure accuracy, reduce chairside adjustment, and facilitate future prosthetic maintenance.

3. Pre-operative Assessment & Initial Situation

Initial clinical examination confirmed generalized attachment loss with significant alveolar bone destruction across the maxillary arch. Occlusal views of both jaws revealed severe periodontal compromise: the upper jaw exhibited generalized bone loss with multiple teeth of guarded-to-hopeless prognosis, while the lower jaw similarly showed bilateral molar involvement requiring staged extraction and treatment. Buccal photography documented the full extent of the aesthetic and functional deficit, confirming deep periodontal pocketing and significant gingival recession throughout the dentition. Cone Beam Computed Tomography (CBCT) was performed to quantify available bone volume, assess bone density, and identify critical anatomical landmarks includs the sinus floor, nasal cavity, and pterygoid process. The panoramic CBCT reconstruction confirmed the clinical findings and provided the volumetric dataset required for virtual implant planning. Following comprehenzive assessment, the clinical team decided to extract the premolars and molars on the upper jaw together with themandibular molars, followed by delayed total implantation of the upper jaw.

 4. Surgical Planning & Implant Configuration 

Virtual implant planning was executed, with CBCT volumetric data merged with high-resolution intraoral scans acquired with composite fiducial markers attached to the palate. The planning video below illustrates the step-by-step virtual placement of the six implants within the available bone volume, including the angulation decisions for each fixture and the collision/clearance verification process. 
Six MegaGen AnyRidge Implants (South Korea) were selected for their proven performance in compromised bone quality. The distal implants were planned in an angulated configuration, with the most posterior fixtures intentionally placed into the pterygoid process — a well-documented strategy for obtaining bicortical anchorage and superior primary stability in the posterior maxilla where sub-sinus bone height is reduced. The CBCT cross-section confirms the final implant positions with all six fixtures clearly visible, demonstrating the progressive angulation from straight anterior to steeply angled posterior pterygoid fixtures. 

 IMPLANT & MULTIUNIT ABUTMENT CONFIGURATION 

5. Intraoral Scanning & Photogrammetry Protocol 
The scanning protocol was structured in two stages. Pre-operatively, a full-arch intraoral scan was performed incorporates the remaining dentition and a palatal fiducial tracer device (JD tracer), establishing the spatial reference for prosthetic planning and enabling direct transfer of tooth position from the diagnostic wax-up into the CAD environment. Post-operatively, following implant placement and multiunit abutment connection, scan caps were installed on all six multiunit abutments, and a photogrammetric scan was acquired — capturing the precise three-dimensional spatial relationships between all six implant positions. The scanning video below documents the complete post-surgical photogrammetry acquisition workflow.

6. CAD Design in Exocad Elefsina  
Prosthetic design was performed in Exocad Elefsina, leveraging its robust full-arch implant module and seamless integration with photogrammetric scan data. A defining feature of this workflow was the direct transfer of tooth positions from the pre-surgical virtual plan — including the diagnostic wax-up geometry — into the Exocad design environment. This wax-up transfer methodology preserves the aesthetic and functional objectives established during treatment planning, removes subjectivity from tooth positioning, and substantially reduces clinical try-in iterations. The CAD design video below shows the complete design session: importing scan data, positioning the arch, designing individual tooth morphology, and generating the final prosthetic STL for printing. 

7. 3D Printing with the Shining3D AccuFab-F1 
The designed full-arch prosthesis was sent directly to the Shining3D AccuFab-F1 for fabrication using Shining3D CX100 resin in shade A2 — engineered to deliver superior mechanical properties, natural translucency, and long-term colour stability. The complete full-arch prosthesis printed in just 21 minutes, enabled by the AccuFab-F1's ultra-high light power engine (12–18 mW/cm²) and dual heating architecture which optimizes ceramic resin viscosity and polymerization uniformity across the entire build platform.

8. Post-Processing & Prosthetic Finishing 
SURFACE GLAZING Following post-curing, the prosthesis was finished with HARZ Labs Glaze, applied to achieve a highlustre, light-reflective surface texture approximating that of natural enamel. Glazing provides a protective surface layer that reduces roughness, minimizes bacterial adherence, and enhances longterm colour stability in the oral environment — a consideration of particular clinical relevance in this patient given his smoking history. 
POLISHING & TI-BASE INTEGRATION The prosthesis was then polished to its definitive surface finish and prepared for ti-base bonding. Six GeoMedi G4840O titanium bases were bonded into the screw-access channels of the printed framework, providing a metal-to-metal screw interface between the ceramic-resin arch and the multiunit abutments. Final retention was achieved using Sigma screws —confirming the screw-retained design as the definitive loading option for optimal retrievability and passive seating verification. 
 

 9. Clinical Delivery, Early Loading & Outcome 
The definitive screw-retained prosthesis was delivered within 72 hours of surgical implant placement, fulfilling the early-loading protocol. Implant loading was confirmed intraorally with excellent passive seating across all six positions, attributable to the photogrammetric scanning accuracy and the dimensional fidelity of AccuFab-F1 printing at 25 μm resolution. Intraoral check views confirmed perfect marginal adaptation of the prosthetic framework, ideal gingival contour, and appropriate occlusal contact distribution. The aesthetic verification — performed with full-face portraits in repose and function — demonstrated successful transfer of the planned aesthetic parameters: natural tooth proportion, correct incisal edge position, harmonious smile arc, and appropriate lip support, fully satisfying the patient's primary treatment motivation.
 

Conclusion  
This case report demonstrates that the integration of photogrammetric implant scanning, wax-up-guided CAD design in Exocad Elefsina, and ultra-fast ceramic resin printing with the Shining3D AccuFab-F1 enables a clinically robust full-arch implant rehabilitation protocol — reducing prosthetic turnaround to 72 hours without compromising accuracy, aesthetics, or prosthetic longevity. For patients presenting with advanced periodontal disease and a strong aversion to removable prosthetics, this digital workflow represents a paradigm shift: the edentulous interval is virtually eliminated, patient psychological distress is minimized, and the delivered prosthetic is accurate, aesthetically refined, and immediately functional. The AccuFab-F1, with its 25 μm printing resolution, 21-minute full-arch print time, and compatibility with high-strength ceramic composite resins, is uniquely positioned to serve as the production engine for the next generation of early- and immediate-loading full-arch implant protocols.