Dr. Nikoloz Tabatadze

Specialization: Prosthodontist
Work experience: 6 years
Place of work: Tbilisi, Georgia

In the doctor’s own words: “My workflow includes the use of an intraoral scanner and a microscope, which results in more accurate and faster outcomes.”

[xgate_case_compat system=”Neobiotech®” platform=”Regular Platform (RP)” connection=”Conical” mua=”V-Type, D-Type 30°” reasons=”Low profile, Passive fit, Angle Correction, Smooth shape”]

Patient summary

• Patient: Female, 42 years old.
• Medical history: Unremarkable (general health is satisfactory).
• Complaints: Aesthetic defect and impaired masticatory function (functional discomfort) in the maxillary region.
• Initial status: The initial clinical picture is shown in the images below. A ceramic prosthesis supported by the roots of vital teeth.
  

Diagnosis and treatment planning

Based on mandatory CBCT imaging, a 3D model was created, which was used for guided implant surgery planning and the digital design of the prosthetic structure.

Based on the results of a comprehensive clinical and radiological evaluation, the following surgical and prosthodontic treatment plan was approved:

• Extraction of all maxillary teeth
• Bone augmentation
• Placement of 6 dental implants (positioning is shown in the pictures below)
• Fabrication of a screw-retained prosthetic structure

Surgical Stage

The surgical phase—tooth extraction and implant placement—was performed sequentially. X-rays show remaining natural teeth next to the placed Neobiotech Regular Platform implants. This approach is necessary for accurate occlusal registration. Furthermore, the remaining teeth can serve as support for provisional restorations if immediate loading of the implants is not clinically indicated.

Prosthetic stage and choice of superstructures

Screw retention is the optimal protocol for full-arch prosthetics supported by a limited number of implants. After being informed of possible alternative treatment plans, the patient consented to the fabrication of a screw-retained prosthetic structure on multi-unit abutments.

The success of comprehensive rehabilitation directly depends on meticulous prosthetic planning. The following multi-unit abutments were selected for this case:

• 1.6 — V-Type (straight), gingival collar height 3 mm
• 1.4 — V-Type (straight), 1 mm
• 2.4 — V-Type (straight), 1 mm
• 2.6 — V-Type (straight), 3 mm

V-Type 3 mm

• 1.2 — D-Type, angled 30°, 1 mm
• 2.2 — D-Type, angled 30°, 2 mm

D-Type 2 mm

In this clinical case, the superstructures are distributed in an unconventional manner: angled multi-unit abutments (D-Type) are placed in the anterior region, and straight ones (V-Type) in the posterior regions. This decision was dictated by the specifics of the occlusal plane formation.

Traditional protocols use the opposite approach: straight abutments are placed anteriorly and angled ones are placed posteriorly to bypass anatomical structures in cases of bone deficiency. However, in this case, bone support in the posterior regions was completely restored via augmentation.

The photo below shows the healed gingiva with XGATE multi-unit abutments in place.

Design features of D-Type and V-Type superstructures

Let’s take a closer look at the clinical rationale for choosing these multi-unit abutments.

The V-Type straight abutments feature a narrow conical geometry capable of compensating for up to 40° of implant divergence. Compared to their angled counterparts, they provide superior distribution of occlusal forces due to the increased contact area between the sleeve and the restorative platform. This is particularly crucial when restoring the posterior region.

Furthermore, the V-Type design allows for a thicker zirconia framework, significantly improving the overall strength and long-term durability of the restoration.

D-Type angled abutments are designed to provide reliable support and address biomechanical challenges in cases of severe implant divergence. The line includes three angulation options (17°, 30°, and 45°), allowing for the correct placement of the prosthetic screw access hole even with a total axial divergence of 74° to 130°.

This protocol utilized D-Type multi-unit abutments with a 30° angulation.

The illustration below, using D-Type abutments as an example, demonstrates the XGATE color-coding system based on gingival collar height. This ergonomic solution significantly simplifies component identification and optimizes the clinician’s workflow during prosthetic appointments.

As with all XGATE Dental restorative components, D-Type multi-unit abutments feature precision-machined interfaces and cross-compatibility with 50+ different implant systems.

This precision is critical when utilizing angled abutments. Because the force distribution vector is shifted, the biomechanical stress placed on both the abutment body and the prosthetic screw increases significantly compared to their straight counterparts.

Returning to our clinical case: we utilized a digital workflow for nearly every phase of this treatment. The accompanying image shows the scan bodies in place, ready for intraoral scanning.

Laboratory Stage: Digital Design and Verification

The next step was the CAD modeling of the prosthetic structure. To ensure manufacturing accuracy and a passive fit, we tried the framework on a 3D-printed working model created from digital scans.

The first photo shows a printed model of the maxilla with laboratory-placed implant analogs. It is necessary to verify the passive fit of the prosthesis.

This is a critical parameter: the structure must fit completely without tension. If the framework “springs” on the model, it will create excessive pressure on the implants in the oral cavity, which will ultimately lead to their failure.

The next image shows a jaw model with a gingival mask applied. It demonstrates the boundary of the patient’s soft tissue, preventing the restoration from pressing on the gingiva and preventing food from becoming trapped underneath. This is how ideal “pink aesthetics” are created.

Next comes the final stage: the finished prosthesis after polishing and final inspection. Afterward, sterilization follows, after which the restoration is delivered to the patient.

In accordance with the prosthetic rehabilitation protocol, a provisional restoration was fabricated and secured in place during the initial stage.

After the functional adaptation period and the final formation of the gingival profile, the provisional restoration was replaced with a permanent full-arch zirconia restoration.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

Dr. Denis Malyutin

Specialization:
Aesthetic prosthodontics, implantology, and digital dentistry.
Professional experience:
over 20 years.

This clinical case is notable for the use of a single standard abutment with a 45° angulation in a clinically challenging scenario. This approach allowed for optimal prosthetic positioning while minimizing the extent of surgical intervention.

Patient Information and Initial Clinical Situation

Treatment objective: Full-arch restoration of the mandible.

Initial clinical assessment:

• The posterior regions of the mandible had been edentulous for an extended period, resulting in significant alveolar ridge atrophy. Implant placement in these areas was not feasible without guided bone regeneration (GBR).
• In the anterior region, six teeth remained along with two retained root fragments. The condition of the remaining teeth was poor, with an unfavorable prognosis for long-term preservation.

Treatment Plan

As preservation of the remaining teeth was deemed non-viable, the following clinical approach was adopted:

• Extraction of all non-restorable teeth and retained root fragments.
• Surgical reduction of the alveolar ridge to establish a level and predictable bone foundation.
• Placement of four dental implants in the anterior mandible, where bone density was sufficient and the risk to the mandibular nerve and other critical anatomical structures was minimal.
• Fabrication and placement of a screw-retained full-arch restoration supported by these four implants: initially a temporary prosthesis, followed by a permanent restoration after osseointegration.

During the preoperative planning phase, it was identified that one implant (marked ’45’ in the illustration) would require placement at a significantly steeper angulation than is typical for this type of procedure, necessitating careful prosthetic planning and the use of an appropriately angled abutment.

To compensate for the pronounced implant angulation and to align the screw access channel with the occlusal plane, a 45° angled abutment from the XGATE Dental product line (Germany) was selected. This abutment facilitated proper prosthetic positioning while maintaining optimal load distribution.

Digital Workflow

It is important to emphasize that a fully digital workflow was essential for managing the complexity of this case.

• Implant positioning, including the selection of length and diameter, was carefully planned using a three-dimensional (3D) digital model.
• The full-arch restoration was designed entirely in a virtual environment, generating all necessary data for precise fabrication and ensuring accurate prosthetic outcomes.

Two surgical guides were designed and fabricated as part of the digital workflow:

• The first guide facilitated alveolar ridge reduction (alveoplasty).
• The second guide was used for precise, guided placement of the dental implants.

Surgical Procedure and Initial Steps

The treatment began with preparation for tooth extraction and alveoplasty.

1. Following administration of local anesthesia, the surgeon reflected the soft tissues and prepared the underlying bone to ensure proper seating and stability of the alveoplasty surgical guide.

2. Using the first surgical guide, the incision line was precisely marked, and alveoplasty of the alveolar ridge was performed concurrently with the extraction of all remaining non-restorable teeth and root fragments. This approach allowed for the creation of a level and predictable bone foundation for subsequent implant placement.

3. Following completion of the alveoplasty, the implant placement guide was accurately seated, and four dental implants were placed in the planned positions within the anterior mandible. This guided approach ensured precise implant angulation and spacing, while minimizing the risk to critical anatomical structures.

4. Immediately following implant placement, XGATE Dental D-Type multi-unit abutments with a height of 3 mm were seated: two straight abutments in the central positions, one 30° angled abutment on the right, and one 45° angled abutment on the left. This configuration facilitated proper prosthetic alignment and ensured optimal emergence of the screw access channels.

Straight

As shown in the image, the 45° angled abutment was positioned higher above the bone level compared to the other abutments. To achieve proper soft tissue integration and to harmonize the gingival contour around the abutment, a connective tissue graft was placed (see image below).

5. Subsequently, the soft tissues were closed using standard suturing techniques, ensuring primary closure and optimal conditions for healing.

6. On the same day, the patient received a pre-fabricated, screw-retained temporary restoration, designed and manufactured in advance as part of the digital workflow. The prosthesis provided immediate functional and aesthetic rehabilitation while supporting the soft tissues during the healing period.

It is important to note that Rosen conical screws were used for prosthesis retention. The design of these screws allows for secure fixation without the need for additional bushings, ensuring a stable and precise connection between the prosthesis and the abutments.

Clinical Outcome

At the conclusion of the surgical and prosthetic procedures, the patient was able to immediately use the temporary restoration while adhering to all post-operative instructions.

Following the completion of soft tissue healing and implant osseointegration, a permanent screw-retained restoration will be fabricated and placed, providing long-term functional stability, optimal load distribution, and satisfactory aesthetic results.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

Dr. Dmitry Oleynikov

With twenty years of clinical experience, he has specialized in implantology and complex prosthodontic restorations for over four years.

Workplace: Almaty, Kazakhstan

This clinical case is of interest due to the elegant solution that allowed for the preservation of vital tooth roots and the restoration of the dentition using a screw-retained prosthesis.
The case was provided by two-time Kazakhstan Endodontic Champion, Dr. Dmitry Oleynikov (Almaty). With twenty years of clinical experience, he has specialized in implantology and complex prosthodontic restorations for over four years.

A digital protocol was utilized for surgical planning and prosthesis fabrication. This approach enabled a superior aesthetic result and ensured a tight soft tissue seal against the prosthesis surface — a result that would have been difficult to achieve without XGATE V-Type multi-unit abutments.

[xgate_case_compat system=”Straumann BL®” platform=”Regular Platform (RP)” connection=”Conical” mua=”V-Type” reasons=”Low profile, Passive fit”]

Initial clinical situation

The patient presented with complications related to a PFM bridge supported by teeth 13, 15, and 17. The root of tooth 15 was compromised, causing pain and severe discomfort for the patient.

Treatment plan and its stages

The old PFM bridge was removed, followed by the extraction of the root remnants of tooth 15.

Three Straumann BL® implants with a standard conical connection were placed in positions 14, 15, and 16. Notably, a short implant was selected for position 16 to avoid penetrating the maxillary sinus and perforating the Schneiderian membrane (see radiograph below).

Restorations in the posterior region are subject to high functional loads; using three implants ensures optimal load distribution, favoring a positive long-term prognosis.

The prosthesis was fabricated from zirconia using CAD/CAM technology. Practitioners will be particularly interested in the choice of multi-unit abutments: V-Type from the German brand XGATE. Please note the profile height and sleeve design in the illustration below.

On the left is a classic multi-unit abutment with a standard cone; on the right is the MUA V-Type with an ultra-low profile. This design allows for increased material thickness at the base of the restoration, enhancing strength and ensuring a smooth emergence profile favorable for soft tissue attachment.

In addition, the MUA V-Type sleeve connection offers increased stability compared to classic multi-unit abutments. This is due to the larger contact surface area between the sleeve and the abutment base: while a classic MUA has a contact area of 6 mm², the V-Type offers 10 mm².

The illustration shows V-Type multi-unit abutments prior to the prosthetic stage: two abutments with a height of 2mm and one abutment with a height of 0.5mm.

Teeth 13 and 17 remained vital; therefore, crowns were fabricated for these prepared teeth.

The screw-retained zirconia bridge and the crowns on teeth 13 and 17 show a precise fit, as seen in the photo below.

The completed restoration, with sealed screw access holes, is aesthetically pleasing and anatomically correct. Masticatory function is fully restored, and the patient is completely satisfied with the result.

The gingival contour around the prosthesis is well-defined; the papillae completely fill the embrasures, and a band of attached keratinized gingiva is clearly visualized and anatomically correct.

The radiograph confirms the integrity of the restoration; marginal bone levels around the implants remain stable.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

This clinical case highlights a successful bone augmentation procedure. This report details the first stage of treatment: the placement of two implants in the upper right quadrant of the maxilla.

[xgate_case_compat system=”XGATE Dental X3″ platform=”Regular Platform (RP)” connection=”Internal Hex” mua=”V-Type” reasons=”Small cone, Free angulation up to 40°, Passive fit, Gingival height color coding”]

The description of this case was provided by Dr. Michael Carmy from California. Dr. Carmy has over 20 years of experience in dentistry, including more than a decade specializing in Dental Implantology and digital workflows.

First, let’s get acquainted with the doctor:

Dr. Michael Carmy

Main areas of expertise: Full Arch Restoration, advanced laser dentistry (LANAP & LAPIP)

Experience: 20 years

Workplace: Rialto, California, USA

Initial Clinical Situation of the Patient

Missing teeth:

• Posterior right maxilla

• Posterior left mandible

Treatment Procedure

The treatment of the maxilla was complicated by significant bone volume deficiency, necessitating bone grafting to enable implant placement. The image below clearly illustrates the limited available bone and indicates the planned implant positions.

To restore the required bone volume, a sinus lift was performed using a technique pioneered by Dr. Istvan Urban, which is characterized by high predictability and stable results.

In essence, this technique differs from a classic sinus lift in that the bone graft material is secured by a dual-membrane approach.

A resorbable collagen membrane is placed in direct contact with the graft material. This membrane dissolves as the site heals (see image below).

Equally important is ensuring the rigidity of the structure containing the graft material. To achieve this, titanium-reinforced PTFE (Teflon) membrane was placed, as shown in the image below.

The following photo shows what the membrane looks like on a CBCT scan. The reinforcing plate and pins that fix the membrane are clearly visible here.

Let’s look at the treatment procedure in more detail.

First, an incision was made and the soft tissue was reflected.

Despite the bone deficiency, two implants were placed:

• Ø5.0 x 10 mm implant in the molar position
• Ø4.2 x 10 mm implant in the premolar position

Next, a lateral window osteotomy was performed to access the maxillary sinus. The bone graft material was then placed into this space.

The composition of the bone graft material is noteworthy. The graft consisted of a 50/50 composite of autogenous bone and a xenograft. The autogenous bone provides viable osteogenic cells for rapid integration, while the xenograft acts as a scaffold, providing volume and structure for new bone formation. If a defect is filled only with autogenous bone, there is a higher risk of resorption before a sufficient volume of new bone can mature.

The mixture was also enhanced with GEM 21S, a growth-factor enhanced bone graft. As a completely synthetic material, it eliminates the risks associated with allografts.

GEM 21S contains a recombinant human platelet-derived growth factor, which stimulates the migration and proliferation of osteoblasts, cementoblasts, and fibroblasts. The addition of this biomaterial promotes mesenchymal stem cell proliferation, angiogenesis, and early osteoblastic activity.

Furthermore, the patient’s own blood, present in the autogenous bone chips, serves as a natural source of platelets and a binding agent, creating a malleable consistency (“sticky bone”). This consistency is ideal for contouring the graft and ensuring its stability at the recipient site.

The “sticky bone” mixture was then carefully packed into the subantral space, elevating the Schneiderian membrane. This graft volume was then covered with the resorbable collagen membrane, as shown in the picture.

Next, a small amount of graft material was placed over the collagen membrane before the non-resorbable membrane was secured over the entire site.

The membrane was stabilized with pins, which are clearly visible on the CBCT scan.

Following the fixation of the PTFE membrane, the flap was repositioned and sutured. Postoperative radiographs were taken, and the patient was dismissed.

The radiograph confirms the implants are in a prosthetically favorable position.

Note: Two implants were also placed in the posterior left mandible according to a standard two-stage protocol. We will not go into details here.

The healing process was monitored by Dr. Carmy over a period of five months. At the intermediate stage, the patient received healing abutments. As shown in the clinical photo, the soft tissues around the abutments demonstrate adequate density and stability.

After the healing phase was completed, 1 mm V-Type multi-unit abutments were placed, as indicated by their corresponding color coding.

The color coding of XGATE multi-unit abutments (MUA) merits special attention, as each height option is assigned a distinct color. The minimum available height is 0.5 mm—a feature not offered by many manufacturers—despite the fact that clinical situations requiring abutments of minimal height occur relatively frequently.

These abutments were selected for their large 10 mm² support surface area and their ability to correct implant angulation discrepancies of up to 40°. Additionally, their low-profile conical design (0.8 mm height) minimizes the risk of thinning the prosthetic material at the abutment interface—a potential issue with other multi-unit systems.

The following images show the final restoration — a screw-retained bridge supported by V-Type multi-unit abutments from the German company XGATE Dental.

The marginal bone level remains stable, and the soft tissue profile has improved significantly compared to the initial condition. However, the image below shows a less-than-ideal contact between the gingiva and the prosthetic restoration, which may require soft tissue correction using a free gingival graft in the future.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

This clinical case, presented by Dr. Sergey Goykhman, is notable not only for combining implants and abutments from different manufacturers but also for demonstrating the importance of standardization and precision in the fabrication of implants and superstructures.

Dr. Sergey Goykhman

Specialization:
Oral Surgery, Orthopedics, Restorative Dentistry, Soft Tissue Management

Place of work:
Israel, Netanya, Obol Dental Center

The key objective of this case is to illustrate the creation of aesthetically elegant and high-quality restorations using low-profile V-Type abutments, which offer enhanced versatility even in cases with limited space.

Patient Summary

An 80-year-old female patient presented with complaints about poor quality of life due to an old clasp-retained removable denture on the mandible that required replacement. She also reported issues with the remaining compromised teeth (#34 and #48). Her general health was satisfactory, and no contraindications or limitations for implant surgery were identified. The preoperative condition is clearly visible in the provided radiographs.

Treatment Plan and Execution

During the diagnostic phase, radiographs and an intraoral scan of the patient’s mandible were obtained. Based on the digital scan data, a surgical guide was fabricated for implant placement.

In the first stage, hopeless teeth #34 and #48 were extracted. Immediate implant placement was performed: six implants were placed, three in the third quadrant and three in the fourth quadrant. A surgical guide was used to ensure precise implant positioning. The implant-abutment interface utilized a standard Internal Hex connection.

Immediately following implant placement, V-Type Multi-Unit Abutments were placed, and healing caps were secured onto them. The abutment cuff height was selected based on mucosal thickness and alveolar ridge anatomy. XGATE, a company specializing in innovative prosthetic solutions, incorporates digital height markings on V-Type abutments (see illustration below).

V-Type MUA

The image below, taken after soft tissue healing, clearly displays the placed V-Type Multi-Unit Abutments (MUA V-Type) and their respective positions:

During the soft tissue healing and osseointegration period, the patient adhered to a soft diet. Upon complete healing and re-evaluation of all clinical parameters, zirconium dioxide bridges were fabricated and delivered.

The outcome is satisfactory from both functional and aesthetic perspectives.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

“My professional work primarily focuses on implant prosthetics. I actively strive to integrate the use of intraoral scanners into everyday clinical practice and fully embrace modern trends in digital dentistry.”

Before moving on to a detailed description of the case, it is advisable to briefly outline the key features of the XGATE Dental MUA V-Type compared to most market alternatives, as these components made the implementation of this clinical protocol possible.

[xgate_case_compat system=”Neobiotech®” platform=”Regular Platform (RP)” connection=”Conical” mua=”V-Type” reasons=”High precision, Passive fit, Gingival height color coding”]

Besides, these abutments are available with ultra-low sleeves measuring just 0.5 mm in height. In clinically challenging situations, they can be used as support elements without forming a screw shaft, avoiding structural weakness in the prosthesis. This approach is also justified in cases where the intended screw channel exit point is located on the buccal surface, potentially compromising the aesthetics of the restoration.

Let’s return to our case.

Patient Summary

Patient: Female, 44 years old
Complaints: Aesthetic and functional discomfort, as well as a desire to replace the previously installed metal-ceramic restoration.

Periodontal status: Significant periodontal pathology was noted: deep periodontal pockets, along with supra- and subgingival calculus and plaque. Grade II tooth mobility was diagnosed in the maxilla; localized deep periodontal and bony defects were observed in specific segments of the mandible. Functional overload caused by a prognathic bite was also detected.

Treatment Plan and Implementation

Based on 3D computed tomography data and a clinical examination, comprehensive oral rehabilitation was planned.

Maxilla: The plan included removing the old prosthesis and teeth, placing dental implants, and fabricating a new prosthesis using a one-stage implantation protocol with immediate loading. Six implants were planned.

Mandible: Despite Grade I-II tooth mobility, taking the patient’s wishes into account, it was decided to preserve her natural teeth as much as possible. Only tooth 3.1 was indicated for extraction. Prosthetic restoration of the lower jaw was performed using prepared teeth with preserved vital roots.

Six standard-diameter Neobiotech dental implants were placed in the maxilla; no narrow-diameter implants were used.

Using an intraoral scanner, a digital impression was obtained. Based on this, a temporary fixed bridge made of PMMA plastic was milled from premilled blanks. The use of premilled blanks ensures high precision and an optimal passive fit of the structure due to the standardized implant/abutment interface.

The patient wore the implant-supported provisional prosthesis for six months.

After the completion of the osseointegration period, straight XGATE V-Type multi-units were selected to manufacture the permanent restoration.

Implant Placement Diagram

Based on the thickness of the soft tissues, the patient received:

• MUA V-type – 1 mm – in positions 21, 24, 26 and 11
• MUA V-type – 3 mm – in positions 13 and 17

Next, using CAD/CAM technologies, a fixed, full-contour zirconia bridge was manufactured, designed for screw retention on titanium sleeves.

The final impression was performed using XGATE digital scan bodies, which made it possible to maintain a fully digital workflow at all stages of treatment.

At implant sites 16 and 23, an angled screw channel technique using Torx-type screws was employed to optimize the positioning of the screw access hole.

The following images show the final treatment result. The patient expressed complete satisfaction with both the functional outcome and the aesthetic aspects of the restoration.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

A clinical case presented by Dr. Michael Carmy from Rialto, California, USA.

This case study by Dr. Carmy demonstrates a comprehensive approach to full maxillary rehabilitation and partial mandibular restoration using XGATE Dental V-Type multi-unit abutments and implants from multiple systems. The uniqueness of this clinical work lies in the combination of immediate implant placement with the root shield technique — which allowed for maximum bone tissue preservation—and a staged prosthetic approach using a temporary PMMA prosthesis to ensure stable esthetics and comfort throughout the treatment.

Particular attention was paid to optimizing load distribution through the use of low-profile multi-unit abutments and a segmented design for the final zirconia bridges. This approach minimizes the risk of overload and increases the long-term durability of the restoration.

This case exemplifies modern rehabilitation, where XGATE Dental technologies help achieve stable biomechanical outcomes and natural esthetics, even in clinically challenging conditions.

[xgate_case_compat system=”DSI, XGATE Dental X3″ platform=”Regular Platform (RP)” connection=”Internal Hex” mua=”V-Type” reasons=”Small cone, Low profile, Passive fit”]

Patient Summary

The patient is a relatively young man in recovery from drug addiction. At the time of his initial consultation, he had been living a healthy lifestyle for three years. Restoring his smile was a high priority, as it is crucial not only for esthetics but also for self-confidence, clear speech, and the ability to maintain a nutritious diet without limitations.

Long-term psychoactive substance use had caused severe xerostomia, contributing to the rapid development of dental caries and decay. The teeth in the upper jaw were non-restorable, and many were already missing. The condition of the lower jaw was slightly better: the anterior teeth were in satisfactory condition, but the posterior teeth were severely decayed and required extraction.

The presented images show the patient’s initial dental condition.

Treatment Plan and Its Adjustment During Execution

The initial plan was to rehabilitate the upper jaw using an All-on-4 protocol with an FP3 Tx prosthesis, which replaces not only the tooth crowns but also the lost gingival (soft) tissue. This approach would have required a significant reduction of the alveolar ridge to accommodate the full-arch prosthesis.

However, after a detailed assessment of the bone volume, height, and density, the decision was made to adjust the treatment plan in favor of a more conservative, bone-preserving strategy.

Stage 1

The implants were placed immediately following tooth extraction. They were positioned subcrestally — 2–3 mm below the bone crest — to allow for anticipated bone remodeling. A total of eight implants were placed in the maxilla and four in the mandible.

Placing the implants into the fresh extraction sockets allowed for optimal positioning for the future prosthetic restoration. The extractions were performed using the root shield technique, which is aimed at maintaining the thickness and height of the buccal and palatal bone walls. This technique, traditionally used for “conservation” even in case of delayed implantation, helps to minimize resorption and preserve the natural morphology of the alveolar ridge.

Implant dimensions were selected based on the patient’s anatomy and the anticipated functional load in each area:

• Molar region: 5.0 x 10 mm
• Anterior region: 3.75 x 15.2 mm
• Mandibular premolar region: 4.2 x 10 mm

For the first two weeks post-surgery, the patient was instructed to follow a soft-liquid diet to promote optimal tissue healing and minimize swelling. Once the mucosa had stabilized and initial healing was complete, the first temporary prosthesis could be delivered.

Stage 2

Two weeks after implant placement, a temporary removable prosthesis was delivered. During this phase, the implants remained non-loaded to allow for undisturbed osseointegration. The prosthesis was carefully designed to support the gingival contours and preserve the interdental papillae, a key factor for achieving optimal esthetics in the final restoration.

The planned final maxillary restoration will consist of several independent zirconia bridges. Separating the posterior and anterior segments in this way creates shorter lever arms, which reduces torque and stress on the implants, preventing loosening and overload.

Currently, the patient is wearing the provisional PMMA prosthesis. He is attending regular professional hygiene appointments and adhering to a strict home care regimen. This transitional period allows for the evaluation of the function and esthetics of the PMMA prosthesis, so that any necessary adjustments can be made before fabricating the final restoration, ensuring an optimal outcome.

The patient’s appearance at this stage demonstrates a natural and harmonious result.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

The key feature of this clinical case is the complete maxillary rehabilitation on 8 implants without the use of artificial gingiva. This approach required precise planning, including both bone augmentation and reduction of the alveolar ridge.

[xgate_case_compat system=”Neobiotech IS-II Active®” platform=”Regular Platform (RP)” connection=”Conical” mua=”V-Type, D-Type 30°” reasons=”Angle correction, High precision, Passive fit, Gingival height color coding”]

A combination of D-Type and V-Type multi-unit abutments by XGATE Dental allowed the team to achieve an optimal fit and excellent aesthetics. The use of zirconia bridge ensured a stable occlusion and a natural smile line.

First, let’s introduce the team responsible for the patient’s treatment:

Dr. Levan Sinatashvili

Specialization:
Maxillofacial Surgery,
Implantology
Place of work:
Tbilisi, Georgia

Patient Information

Female, 57 years old

General health is satisfactory.

The patient presented with functional and aesthetic discomfort, and there was a categorical requirement not to use artificial gingiva to achieve a visual effect.

A 3D Cone Beam Computed Tomography (CBCT) scan was performed.

Based on the scan analysis, the treatment plan included the extraction of all remaining maxillary tooth roots, bone augmentation (using InterOss), and the placement of eight Neobiotech IS-II Active implants.

An alveoloplasty of the maxilla was also required.

Following the osseointegration period, the multi-unit abutments were selected based on the soft tissue height:

• 1 mm angled D-Type 30° XGATE Dental – 3 units.
• 1 mm straight V-Type XGATE Dental – 5 units.

D-Type

After scanning, a temporary prosthesis was fabricated. It was used to contour the soft tissues and stabilize the patient’s occlusion.

The smile design and tooth morphology were refined.

For the final stage, the temporary prosthesis was replaced with the permanent zirconia bridge.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States

The key feature of this clinical case is the full-mouth rehabilitation of both the maxilla and mandible with fixed, screw-retained prostheses using two types of XGATE multi-unit abutments: D-Type and V-Type.

The use of a titanium framework veneered with zirconia ensured both durability and high aesthetics. Additionally, implementing a digital protocol with an intraoral scanner allowed for a precise, passive fit and required minimal adjustments.

[xgate_case_compat system=”Neobiotech IS-II Active®” platform=”Regular Platform (RP)” connection=”Conical” mua=”V-Type, D-Type 30°” reasons=”Angle correction, High precision, Passive fit, Gingival height color coding”]

This case demonstrates a comprehensive approach to restoring function and aesthetics in a patient with a terminal dentition, utilizing modern digital and surgical solutions to transition to full-arch fixed prostheses.

First, let’s introduce the team responsible for the patient’s treatment:

Dr. Levan Sinatashvili

Specialization:
Maxillofacial Surgery,
Implantology
Place of work:
Tbilisi, Georgia

Patient Summary

Male, 49 years old

General health is satisfactory.

The patient presented with functional and aesthetic concerns related to failing restorations supported by his natural teeth. Over time, the occlusion had failed, and the structural integrity of the abutment teeth was compromised.

A comprehensive clinical and radiographic examination, including a Cone Beam Computed Tomography (CBCT) scan, was performed. Based on the findings, a decision was made to extract all remaining teeth in the maxilla and mandible and rehabilitate both arches with fixed, screw-retained prostheses.

The clinical situation after removing the old restorations is shown below.

Treatment Planning and Implementation

The CBCT analysis revealed that it was necessary to perform localized bone augmentation with InterOss osteoplastic material concurrently with implant placement.

A total of 12 Neobiotech IS-II Active implants were placed: six in the maxilla and six in the mandible.

Following the osseointegration period and soft tissue healing, the prosthetic phase commenced. Given the span of the restorations, screw retention was the only way to ensure a good passive fit.

In accordance with the patient’s needs, the following two types of XGATE multi-unit abutments were immediately placed:

• Angled D-Type 30° – used in the upper jaw, available in heights of 1 mm, 2 mm,
  and 3 mm.
• V-Type – used in the lower jaw, with a height of 3 mm.

V-Type

D-Type

In this situation, the optimal solution was a prosthesis with a titanium frame and zirconium dioxide coating.

Multi-unit abutments made it possible to compensate for divergent implant angulations without additional processing.

The active use of digital technologies, especially intraoral scanners, helped minimize the number of try-in appointments and adjustments.

After try-in and adjusting the data, permanent full-arch prostheses with a titanium frame and zirconia dioxide coating were fabricated.

We hope you found this clinical case interesting. If you have any questions about the characteristics and delivery of XGATE Dental products, please contact us in any convenient way.

XGATE Dental Group GmbH
Falkensteiner Straße 77, 60322
Frankfurt am Main
Germany

E-mail: info@xgate.dental
350 W Passaic
St Rochelle Park, NJ 07662
United States