After a full digital workup using a facial scanner, digital diagnostic wax-up, and virtual patient creation to determine the ideal position of the teeth, we designed stackable guides to save time and maximize efficiency.

The first guide used the existing dentition as a reference to create niches for guide pins. That guide was removed, and then teeth were extracted. A second guide was used to control the amount of bone reduction and to serve as a base for the next guide, which contained the information on the position and orientation of the implants relative to the ideal tooth position.

Implants were placed, and the implant guide was removed, leaving the reduction guide in place to serve as support for the PMMA prosthesis, which was ready to be connected to the newly placed implants.

The prosthesis was placed, and temporary cylinders were picked up using acrylic resin. Final finishing was achieved by adding gingival composite as needed.