Full-Arch Restoration of the Maxilla Using a Digital Protocol and Ultra-Compact XGATE Dental V-Type Multi-Units

This clinical case is of interest due to the combination of a digital protocol and the use of ultra-low profile multi-unit abutments. This combination allows for the most secure fit of the restoration to the alveolar ridge and, in some situations, eliminates the need for angled abutments—provided that the inter-implant divergence angle does not exceed 40°.

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.

Firstly, they feature a large contact area for the support sleeve—specifically 10 mm², as opposed to 6 mm² in the previous generation of MUAs. This makes the screw connection more stable and durable.

Secondly, they offer the opportunity to create a durable restoration in conditions of insufficient space between the implant platform and the antagonist tooth.

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.

General health: Generally healthy.

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

Please note: The color marking of the MUA V-type determines the gingival height.

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.