Int J Stomatol ›› 2022, Vol. 49 ›› Issue (4): 426-431.doi: 10.7518/gjkq.2022075

• Case Report • Previous Articles     Next Articles

Centric relation centered, facial esthetically and prosthetically driven digital workflow for edentulism implant rehabilitation: a clinical report

Luo Qiyue(),Liu Yeyu,Luo Yilin,Man Yi.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-01-05 Revised:2022-04-29 Online:2022-07-01 Published:2022-06-28
  • Contact: Yi. Man;
  • Supported by:
    Sichuan Province Science and Technology Planning Project(2022YFS0041)


This clinical report proposed a digital workflow for edentulism implant rehabilitation. 3-dimensional (3D)-printed individual trays and Gothic arch were used to obtain optimal fit with the patient’s soft tissue and centric relation recording. A 3D virtual patient was created with craniofacial hard tissue, intraoral soft tissue and extraoral facial profile after data superimposition of cone beam computed tomography (CBCT) volumetric data, scanned impression data and 3D extraoral facial scan. Tooth alignment was performed in correct centric relation and virtual smile design under the gui-dance of 3D virtual patient. All data could be collected in only two clinical appointments. Computer-guided implant surgery and computer-assisted design and computer-assisted manufacturing (CAD/CAM) interim prostheses were finished, allowing functional and esthetic rehabilitation in a predictable way.

Key words: edentulism implant rehabilitation, digital workflow, centric relation, facial scan, computer-aided design and computer-aided manufacturing

CLC Number: 

  • R 782.12


Fig 1

Intraoral pretreatment condition"

Fig 2

Postoperative situation"

Fig 3

Esthetic results"

1 The glossary of prosthodontic terms: ninth edition[J]. J Prosthet Dent, 2017, 117(5S): e1-e105.
2 Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme[J]. Community Dent Oral Epidemiol, 2005, 33(2): 81-92.
3 Rosenfeld AL, Mandelaris GA, Tardieu PB. Prosthetically directed implant placement using compu-ter software to ensure precise placement and predic-table prosthetic outcomes. Part 2: rapid-prototype medical modeling and stereolithographic drilling guides requiring bone exposure[J]. Int J Periodontics Restorative Dent, 2006, 26(4): 347-353.
4 Joda T, Gallucci GO. The virtual patient in dental medicine[J]. Clin Oral Implants Res, 2015, 26(6): 725-726.
5 Li J, Sommer C, Wang HL, et al. Creating a virtual patient for completely edentulous computer-aided implant surgery: a dental technique[J]. J Prosthet Dent, 2021, 125(4): 564-568.
6 Li JY, Chen ZZ, Dong B, et al. Registering maxillomandibular relation to create a virtual patient integrated with a virtual articulator for complex implant rehabilitation: a clinical report[J]. J Prosthodont, 2020, 29(7): 553-557.
7 Gabriel PM, Mehrad S, Marta R. Virtual 3-dimensional representation of a completely edentulous patient for computer-aided static implant planning[J]. J Prosthet Dent, 2021. doi: 10.1016/j.prosdent.2021 .038.
doi: 10.1016/j.prosdent.2021
8 Behl N. ITI treatment guide. Volume 4: loading protocols in implant dentistry. Edentulous patients[J]. Br Dent J, 2011, 210(8): 390.
9 Qu F, Du X, Liu WC. 3D-printed custom trays with a Gothic arch for centric relation recording and definitive impression making for complete dentures: a dental technique[J]. J Prosthet Dent, 2018, 121(1): 32-36.
10 Watanabe Y. Use of personal computers for Gothic arch tracing: analysis and evaluation of horizontal mandibular positions with edentulous prosthesis[J]. J Prosthet Dent, 1999, 82(5): 562-572.
11 Obrez A, Stohler CS. Jaw muscle pain and its effect on gothic arch tracings[J]. J Prosthet Dent, 1996, 75(4): 393-398.
12 Mongini F, Capurso U. Factors influencing the pantographic tracing of mandibular border movements[J]. J Prosthet Dent, 1982, 48(5): 585-598.
13 Hassan B, Gimenez Gonzalez B, Tahmaseb A, et al. A digital approach integrating facial scanning in a CAD-CAM workflow for complete-mouth implant-supported rehabilitation of patients with edentulism: a pilot clinical study[J]. J Prosthet Dent, 2017, 117(4): 486-492.
14 Papaspyridakos P, Barizan Bordin T, Kim YJ, et al. Implant survival rates and biologic complications with implant-supported fixed complete dental prostheses: a retrospective study with up to 12-year follow-up[J]. Clin Oral Implants Res, 2018, 29(8): 881-893.
15 Per A, Jan A, Johan G, et al. Implant treatment of patients with edentulous jaws: a 20-year follow-up[J]. Clin Implant Dent Relat Res, 2008, 10(4): 207-217.
16 Papaspyridakos P, Bordin TB, Natto ZS, et al. Double full-arch fixed implant-supported prostheses: outcomes and complications after a mean follow-up of 5 years[J]. J Prosthodont, 2019, 8(4): 387-397.
17 Kopp KC, Koslow AH, Abdo OS. Predictable implant placement with a diagnostic/surgical template and advanced radiographic imaging[J]. J Prosthet Dent, 2003, 89(6): 611-615.
18 de Wiele Gerlinde V, Wim T, Marjolein V, et al. The accuracy of guided surgery via mucosa-supported stereolithographic surgical templates in the hands of surgeons with little experience[J]. Clin Oral Implants Res, 2015, 26(12): 1489-1494.
19 Raico Gallardo YN, da Silva-Olivio IRT, Mukai E, et al. Accuracy comparison of guided surgery for dental implants according to the tissue of support: a systematic review and meta-analysis[J]. Clin Oral Implants Res, 2017, 28(5): 602-612.
20 Vercruyssen M, Laleman I, Jacobs R, et al. Compu-tersupported implant planning and guided surgery: a narrative review[J]. Clin Oral Implants Res, 2015, 26(): 69-76.
21 Tim J, Urs B, German G. Systematic literature review of digital three-dimensional superimposition techniques to create virtual dental patients[J]. Int J Oral Maxillofac Implants, 2015, 30(2): 330-337.
22 Thakur M, Jain V, Parkash H, et al. A comparative evaluation of static and functional methods for recording centric relation and condylar guidance: a clinical study[J]. J Indian Prosthodont Soc, 2012, 12(3): 175-181.
23 Kattadiyil MT, Alzaid AA, Campbell SD. What materials and reproducible techniques may be used in recording centric relation? Best evidence consensus statement[J]. J Prosthodont, 2021, 30(S1): 34-42.
24 Linsen SS, Stark H, Samai A. The influence of different registration techniques on condyle displacement and electromyographic activity in stomatognathically healthy subjects: a prospective study[J]. J Prosthet Dent, 2012, 107(1): 47-54
25 Nitecka-Buchta A, Proba T, Proba P, et al. Functio-nal assessment of the stomatognathic system, after the treatment of edentulous patients, with different methods of establishing the centric relation[J]. Pain Res Manag, 2018, 2018: 1572037.
26 Barry R, Hill Edward E. Intraoral gothic arch tracing[J]. N Y State Dent J, 2011, 77(5): 40-43.
27 Krimmel M, Breidt M, Bacher M, et al. Three-dimensional normal facial growth from birth to the age of 7 years[J]. Plast Reconstr Surg, 2015, 136(4): 490e-501e.
28 Tzou CHJ, Frey M. Evolution of 3D surface ima-ging systems in facial plastic surgery[J]. Facial Plast Surg Clin N Am, 2011, 19(4): 591-602, vii.
29 Sforza C, Ulaj E, Gibelli DM, et al. Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures[J]. Br J Oral Maxillofac Surg, 2018, 56(1): 3-7.
30 Pozzi A, Arcuri L, Moy PK. The smiling scan technique: facially driven guided surgery and prosthetics[J]. J Prosthodont Res, 2018, 62(4): 514-517.
31 Coachman C, Calamita MA, Coachman FG, et al. Facially generated and cephalometric guided 3D digital design for complete mouth implant rehabilitation: a clinical report[J]. J Prosthet Dent, 2017, 117(5): 577-586.
32 Harris BT, Montero D, Grant GT, et al. Creation of a 3-dimensional virtual dental patient for computer-guided surgery and CAD-CAM interim complete removable and fixed dental prostheses: a clinical report[J]. J Prosthet Dent, 2017, 117(2): 197-204.
33 AJDM Costa, Teixeira Neto AD, Burgoa S, et al. Fully digital workflow with magnetically connected guides for full-arch implant rehabilitation following guided alveolar ridge reduction[J]. J Prosthodont, 2020, 29(3): 272-276.
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[3] Xue Du,Fang Qu,Weicai Liu. Establishment of a three-dimensional virtual dental patient and its application in esthetic restoration [J]. Inter J Stomatol, 2018, 45(6): 695-702.
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