A Case Report · Visual Essay for the Contemporary Clinician

Hybridge’s Digital Restorative Workflows

Combining Intraoral Scanning, Photogrammetry, and Gen 5 Prostheses

Julian Conejo, DMD

Alejandro Sanchez-Lara, DDS

Michael Baleno, DDS

Cristina Rivet, CDT

Frank LaMar, DDS

Abstract

Full-arch implant rehabilitation has evolved from analog complexity to digital precision. This case report highlights how the integration of intraoral scanning and photogrammetry enhances accuracy, efficiency, and predictability all while ensuring a passive-fitting prosthetic framework, the cornerstone of long-term success.

Clinical Challenge

Restoring a fully edentulous arch presents inherent difficulties:

Distortion in conventional impressions
Time-consuming workflows
Risk of misfit in long-span frameworks

Achieving a “passive fit” remains critical to avoid biologic and mechanical complications.

Digital Workflow Overview

Intraoral Scanning

Captures soft tissue anatomy, provisional prostheses, and occlusion
Improves patient comfort and reduces chair time

Clinical Step 1

Evaluate and modify the immediately loaded provisionals for optimized esthetics. Scan upper, lower and bite after modifications to share with laboratory.

Photogrammetry Acquisition

Records precise 3D implant positions using scan flags
Eliminates stitching errors common in full-arch scans

Clinical Step 2

Remove the provisionals and scan the fully healed soft tissue. Place the scan flags and capture the implant positions using the photogrammetry feature. Do the same for the lower arch.

Key Insight

Intraoral scanners alone may accumulate errors over long spans.

Photogrammetry compensates by delivering true implant spatial relationships, ensuring restorative accuracy.

Data Integration

Merging intraoral scans (soft tissue and provisionals) with photogrammetry (implant positions) produces a highly accurate digital master model.

CAD/CAM Framework Design

Digitally designed framework based on verified implant coordinates
Fabricated with high precision milling or additive manufacturing

Clinical Step 3

After uploading all files to the Hybridge Lab portal, review the final prostheses design and approve. After this, the team will manufacture the Hybridge Gen 5 hybrid prostheses with a CoCr framework, which is 3D laser printed followed by detailed milling of the interfaces. The teeth are 3D printed from a nanoceramic material followed by pink PMMA injection.

The Passive Fit Imperative

A passive-fitting framework is not optional – it is essential.

Mechanical Benefits

Prevents screw loosening and fractures
Enhances prosthesis longevity

Biologic Benefits

Reduces peri-implant bone stress
Minimizes inflammation and bone loss

Digital Advantage

Verification of fit can be done virtually before fabrication
Reduced need for intraoral adjustments

Clinical Outcome

Accurate prosthetic seating without strain
Minimal chair-side adjustment
Improved patient comfort and confidence
Streamlined communication between clinic and laboratory

Laboratory Perspective

The digital workflow transforms the laboratory process:

Eliminates physical casts prone to distortion
Enables repeatable, scalable production
Facilitates collaborative planning with clinicians
Supports archival of digital cases for future reference

Clinical Step 4

Try-in and delivery of upper and lower Gen 5 hybrid prosthesis with a passive fitting framework and esthetically designed, functional teeth providing efficient mastication and phonetics, giving back a confident smile to the patient.

Take-Home Message

The synergy of intraoral scanning and photogrammetry represents a paradigm shift in full-arch dentistry:

Accuracy is no longer compromised by span length
Passive fit becomes predictable, not aspirational
Clinical and laboratory workflows are unified digitally

Conclusion

Modern full-arch rehabilitation demands precision. By leveraging digital technologies, particularly the combination of intraoral scanning and photogrammetry, clinicians can deliver restorations that are not only efficient and aesthetic, but biologically and mechanically sound. Digital accuracy is not just innovation – it is responsibility.