Category Archives: Implant Restoration

Case fabricated at Khai Nguyen Dental Lab to the treating dentist’s prescription, presented in our laboratory brochure. No patient-identifying information is included.

Case summary

FP1 full-arch prosthesis on six implants, facial view.

Background

The patient, a Vietnamese American who travels between Vietnam and the US for work, had previous dental treatment, but complications began to appear around October 2023. After clinical evaluation and consultation, he opted for a full-arch upper restoration on six implants for long-term function and improved esthetics.

Treatment plan

1. The dentist selected the AnyRidge implant system by Megagen.
2. After implant placement the patient was immediately loaded with a provisional restoration before returning to the US.
3. In October 2024 the patient returned to Vietnam for final impressions and the esthetic restoration.
4. The case was completed with a full-arch FP1 prosthesis on six implants, without gingiva, fabricated by Khai Nguyen Dental Lab.

Occlusal view of the prosthesis: screw access positions and posterior anatomy.

Why FP1 is the harder option

An FP1 prosthesis replaces only the crowns, with no pink porcelain to hide the cervical area, so the cervical contours, embrasures and implant positions must match the patient’s own gingiva. It suits cases where bone and soft tissue allow normal crown length; with greater tissue loss, the prosthesis needs pink gingiva. For a patient living abroad, appointments are few and far apart, so the data sent to the lab at the final impression has to be complete the first time.

The definitive prosthesis in the mouth, frontal view with a lip retractor.

Takeaways

• Send everything at once: scan bodies on every implant, the bite, smile photos and photos of the accepted provisional.
• Use the provisional as the blueprint for tooth shape and length in the definitive prosthesis.
• Choose FP1 or pink gingiva by the remaining tissue, not by esthetic preference.

See also implant bridges and crowns, All-on-4 FP1: the polished tissue surface, or contact Khai Nguyen.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.

Summary: the abutment determines three things at once — whether the peri-implant soft tissue stabilises, whether the restoration can be screw-retained or has to be cemented, and the aesthetic result anteriorly. This article covers stock and custom abutments, when angulation correction is needed, and a decision tree by clinical situation.

Stock abutments: when they are enough

Manufacturer stock abutments have real advantages: the implant connection is produced within the manufacturer’s own tolerances, they are available immediately, and they cost less. They are sufficient when three conditions hold together: the implant is placed on axis, the shoulder is not excessively deep, and the site does not demand high aesthetics.

Their limitation is the emergence profile. Stock abutments are bodies of revolution, while a natural cervical cross-section is not round — incisors are flattened bucco-palatally, molars wider mesio-distally. Anteriorly, that discrepancy shows as an asymmetric gingival margin.

Custom abutments: what the extra buys

An emergence profile matched to the intended form

This is the main reason. A custom abutment allows each surface to be designed separately: slightly concave adjacent to the implant shoulder to leave room for tissue, then widening to the actual cross-section of the tooth being replaced. Whether the soft tissue stabilises is largely decided in that segment.

Margin position set where you want it

The margin can sit shallower palatally and deeper facially — something a stock abutment cannot do because its margin lies in a single plane. A shallow palatal margin makes excess cement controllable if the case must be cemented.

Height and taper matched to the real situation

With limited interocclusal space, a custom abutment preserves the maximum available height instead of grinding down a stock abutment — and grinding usually destroys the surface treatment as well.

Abutment materials

• Titanium. The strongest option, well tolerated by tissue, the default posteriorly and wherever loads are high.
• Zirconia on a titanium base. For the aesthetic zone where the mucosa is thin and titanium greyness could show through. The implant connection remains titanium — an important point, because zirconia in direct contact with a titanium implant connection causes micro-wear.
• Full zirconia. Only to be considered at low-load sites and where the implant manufacturer has validated that configuration.

Correcting the axis

Implants are rarely placed exactly on the intended prosthetic axis. When the axis deviates there are three routes:

• Angled abutment — redirects the upper portion, restoration stays screw-retained.
• Angulated screw channel — keeps the abutment straight but allows the driver to enter from a different direction, moving the channel off the facial surface.
• Cementation — solves any angle, at the cost of residual subgingival cement risk.

Practical order of preference: preserve screw retention by every available means, and switch to cementation only when the margin can sit equigingival or supragingival. The hybrid abutment crown preserves both advantages — see hybrid abutment crowns on a titanium base.

The evidence base: where custom outperforms stock

The geometric difference has been measured. Custom abutments have wider emergence angles, in the region of 20–30 degrees, compared with roughly 11–15 degrees for prefabricated ones; custom abutments also follow the dimensions of the individual socket, whereas stock abutments have a smaller circular cross-section.

On clinical outcomes, a systematic review of peri-implant conditions and aesthetic outcomes of customised versus conventional healing abutments reported that none of the included studies found biological or aesthetic disadvantages for customised abutments, and that this group maintained peri-implant hard and soft tissue stability. Two randomised controlled trials in immediate implant placement (PMC12991680, PMC12385633) point in the same direction.

One aspect is less often discussed: surface quality. A microscopy evaluation of emergence profile surfaces compared custom CAD-CAM abutments with stock abutments — a reminder that the surface finish of the subgingival segment is a separate variable, independent of shape.

Decision tree

• Posterior, good axis, thick tissue, adequate interocclusal space → stock titanium abutment, screw-retained.
• Posterior, deviated axis → angled abutment or angulated screw channel, still screw-retained.
• Anterior, thick tissue, good axis → custom titanium abutment.
• Anterior, thin tissue → custom zirconia abutment on a titanium base.
• Limited interocclusal space → custom abutment to use every available millimetre.
• Multi-unit bridge on non-parallel implants → consider a hybrid assembly or a bar.

What the laboratory needs

• Implant system, line and platform diameter — exactly, not approximately.
• A photograph of the emergence profile immediately after removing the healing abutment.
• Implant shoulder depth relative to the facial gingival margin.
• Mucosal thickness, if measured.
• Opposing model, bite registration and a note on bruxism.

FAQ

Is a custom abutment always better?

No. Posteriorly, on axis, with thick tissue, a stock abutment gives an equivalent result at lower cost. The benefit of customisation rises with aesthetic demand and with axis deviation.

Can full zirconia be used posteriorly?

Not advisable unless the implant manufacturer has validated it. A zirconia–titanium connection under cyclic posterior loading is prone to micro-wear and screw loosening.

How deep should the abutment margin sit?

The shallower the better. The facial aspect in the aesthetic zone may need more depth, but where the case uses a hybrid assembly, extraoral bonding has already removed the main reason to worry about depth.

Can an abutment be reused when the restoration is remade?

Yes, if the abutment is intact and the screw is replaced. The screw is always replaced — a screw that has been torqued once should not be reused.

References

• Systematic review of peri-implant conditions and aesthetic outcomes of customized versus conventional healing abutments. PMC11635071.
• Custom vs Stock Healing Abutments on Peri-Implant Tissue Integrity in Immediate Implant: A Randomized Controlled Study. PMC12991680.
• Comparative Evaluation of Customized CAD/CAM vs. Stock Titanium Abutments for Immediate Implant Placement in Class II Extraction Sockets: A Randomized Controlled Trial. PMC12385633.
• A Microscopy Evaluation of Emergence Profile Surfaces of Dental Custom CAD-CAM Implant Abutments and Dental Implant Stock Abutments. PMC11278322.
• Effect of Customized and Prefabricated Healing Abutments on Peri-Implant Soft Tissue and Bone in Immediate Implant Sites: A Randomized Controlled Trial. PMC10856257.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.

Summary: the hybrid abutment crown combines the advantages of screw retention and of adhesive bonding: the ceramic crown is bonded to a titanium base extraorally, and the assembly is then screwed onto the implant. This article covers why that solves the weaknesses of both original options, what the extraoral bonding protocol requires, and when intraoral cementation is still the right choice.

The problem with each original option

Direct screw retention

Its greatest advantage is retrievability: for repair, for cleaning, for implant complications. With no cement there is no risk of residual cement subgingivally. The drawback is that the screw channel sits on the occlusal or facial surface, taking up space and compromising aesthetics anteriorly, while also weakening an all-ceramic restoration precisely where it carries load.

Intraoral cementation

It allows the restoration to be positioned aesthetically regardless of implant axis, with no screw channel. Its serious drawback is excess subgingival cement: hard to detect, hard to remove completely, and a well-documented contributor to peri-implantitis. The deeper the margin, the less controllable the residue.

How the hybrid abutment crown resolves this

The ceramic crown is bonded to the titanium base extraorally, in the laboratory, under controlled conditions: clean surfaces, a correct surface-treatment protocol, a measured quantity of cement, and complete removal of excess followed by polishing before the case leaves the lab. The assembly is then screwed onto the implant like any screw-retained restoration.

The result: no subgingival cement, full retrievability, and a screw channel that can be redirected using an angled base or an angulated screw so it does not emerge facially.

The extraoral bonding protocol

Titanium surface

The titanium base is air-abraded with aluminium oxide at low pressure, cleaned, then treated with a phosphate-monomer primer. Skipping air abrasion reduces bond strength markedly and the restoration may debond from the base within months.

Ceramic surface

This differs by material. Lithium disilicate is etched with hydrofluoric acid and silanated. Zirconia cannot be acid-etched — it requires mechanical roughening and a phosphate-monomer primer. Applying the wrong protocol to the wrong material compromises the bond from the outset.

Cement control

Use a dual-cure or chemically cured resin cement, in adequate but not excessive quantity, and remove excess at the gel stage. Once polymerised, the entire ceramic–titanium junction must be polished, especially the portion that will sit subgingivally.

The evidence base: strength and surface protocol

The surface protocol above is not house convention — it is the protocol used in the in vitro literature: titanium bases air-abraded with 50 µm Al₂O₃; zirconia abutments and crowns sandblasted; lithium disilicate etched with 9% hydrofluoric acid and silanated; bonded with a dual-cure resin cement.

On strength, an in vitro study of nine abutment and crown material combinations in the premolar region reported the highest fracture strength for the zirconia abutment–zirconia crown combination (about 1,417 N), followed by lithium disilicate abutment–zirconia crown (about 1,349 N). Retention studies on titanium bases report higher values for adhesive and self-adhesive resin cements than for conventional cements, and emphasise the role of surface pretreatment and MDP-containing primer systems.

On fit, an in vitro study examines internal fit and marginal adaptation of hybrid abutment crowns with custom-milled screw channels on titanium bases.

Emergence profile — what determines soft tissue

An implant is narrower than the tooth being replaced, so the contour from the implant shoulder up to the gingival margin always has to widen. Get that segment wrong and the soft tissue will not stabilise, whatever the material quality.

A practical principle: keep the portion adjacent to the implant shoulder slightly concave to leave room for tissue, and widen only as the gingival margin approaches. The entire subgingival surface must be smooth and polished.

When intraoral cementation is still appropriate

• Multi-unit implant bridges on non-parallel implants, where a screw-retained assembly has no common path of insertion.
• Cases requiring more axis correction than the available angled bases allow.
• Where the restoration margin is equigingival or supragingival, so excess cement is visually controllable.

The common condition for all three: the margin is not deeply subgingival. That is the practical boundary between “cementable” and “should not be”.

What the laboratory needs

• The exact implant system and base reference — manufacturer, line, platform diameter.
• A matching scan body or impression coping, securely seated and recorded.
• A photograph of the emergence profile immediately after removing the healing abutment, within the first seconds before the tissue collapses.
• A note on the preferred screw-channel direction in the aesthetic zone.
• Opposing model and bite registration.

FAQ

Is it as durable as direct screw retention?

The ceramic–titanium bond is durable when the surface protocol is followed. The practical weak point is not bond strength but omitted surface treatment or the wrong primer for the material.

Can it be retrieved and remade?

The whole assembly is retrievable via the screw. Separating the crown from the base usually sacrifices the ceramic.

Zirconia or lithium disilicate?

It depends on site and load. Zirconia posteriorly and for bridges; lithium disilicate for single aesthetic units because of its translucency. The materials comparison sets out strength and minimum thickness by group.

Does an angled base weaken the restoration?

Not if ceramic thickness around the screw channel still meets threshold. Problems arise when the axis deviates enough that the channel encroaches on a functional cusp — at which point implant position, or a different approach, should be reconsidered.

References

• Fracture Strength of Implant-Supported Hybrid Abutment Crowns: An In Vitro Study of Ceramic and Polymer-Based Materials in the Premolar Region. J Clin Med, PMC12693155.
• Fracture resistance of implant-supported monolithic crowns cemented to zirconia hybrid-abutments: zirconia-based crowns vs. lithium disilicate crowns. PMC5829289.
• Internal fit and marginal adaptation of all-ceramic implant-supported hybrid abutment crowns with custom-milled screw-channels on titanium-base: in-vitro study. PMC11391652.
• The Effect of Zirconia Material and the Height of the Ceramic Coping on the Strength of Hybrid Ti-Ceramic Abutments. PMC12293803.
• Tensile Retention of Lithium Disilicate and Zirconia Crowns Cemented to One-Piece Zirconia Implants. PMC13514237.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.

Written for dentists and dental technicians, based on the clinical meeting between Khai Nguyen Dental Lab and Vien Dong Dental Clinic (October 2025), the seminar with Viet Dang (March 2026) and the full-arch cases the lab produces.

Recording implant positions for a full arch is the step where most cases go wrong. With four to six implants in one arch, a single abutment misplaced by a few tens of microns leaves the framework without passive fit, and all the esthetic work that follows becomes pointless. Intraoral photogrammetry (IPG) is the approach increasingly used to solve this, and it is the topic Khai Nguyen discussed with the clinicians of Vien Dong Dental Clinic and brought into the March 2026 seminar.

Three ways to record a full arch, and the limits of each

Photo above: Clinical meeting on photogrammetry for full-arch implant restorations with Vien Dong Dental Clinic, October 2025.

What IPG solves

The strength of photogrammetry is that accuracy does not degrade with the distance between abutments. Because the system computes each marker’s position by intersection from images taken at different angles, error does not accumulate along the arch as it does when consecutive scan frames are stitched. In a fully edentulous arch, where no natural teeth provide stitching references, this is the decisive difference.

For the lab, IPG data means implant positions arrive digitally and already verified, so verification-jig checks on the model shorten considerably or need not be repeated. That is why cases such as the full-arch zirconia overlay on a titanium iBar or upper and lower All-on-X can go straight into design instead of waiting through several framework try-ins.

Clinic and lab workflow

1. Remove the provisional and attach photogrammetry markers to the multi-unit abutments. Check they are fully tightened and do not obscure one another at the capture angles.
2. Capture with the photogrammetry device. It computes the three-dimensional position of each abutment and exports an implant position file.
3. Scan the soft tissue and the opposing arch. This step cannot be skipped: IPG gives abutment positions, while gingival contour, ridge form and the opposing arch must come from an intraoral scan.
4. Scan the provisional if the patient is wearing one comfortably; it is the most valuable data on vertical dimension, smile line and lip support.
5. Send the lab three data sets plus facial photos: the implant position file, the soft-tissue and opposing scans, and the provisional scan.
6. The lab merges the data, aligning implant positions to the soft-tissue scan, designs the teeth first, then reduces to a framework or bar, mills and checks passive fit.

What IPG does not replace

• It does not replace the soft-tissue scan. Many cases arrive without it, leaving the lab with abutment positions but no gingival contour for designing the tissue surface.
• It does not replace a clinical fit check. For a full-arch bridge, an intraoral single-screw test remains the final check before the ceramic work is completed.
• It does not replace esthetic information. Vertical dimension, midline and lip support still have to be established by the dentist, usually through provisionals.

If you do not have photogrammetry equipment

Full-arch cases are entirely feasible without it. Khai Nguyen accepts all three data types: conventional splinted impressions, intraoral scans with scan bodies, and IPG files. For the first two the lab will propose a verification jig for an intraoral check before the framework is milled, and this step is worth keeping: a verification jig costs far less than re-milling a titanium bar.

To discuss the data workflow for a full-arch case, contact us on WhatsApp +84 902 945 585. See also bar-supported full-arch restorations and the scan file formats we accept.

Source: Khai Nguyen Dental Lab Facebook page, posts of 3 October 2025 and 28 February 2026.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.

Written for dentists and dental technicians, based on the bar-supported full-arch cases Khai Nguyen Dental Lab published on Facebook and Instagram between June 2025 and July 2026. Photos were taken by the lab; no patient-identifying information is included.

For fixed full-arch implant restorations the question dentists most often put to the lab is: screw a zirconia bridge directly to the multi-unit abutments, or mill a titanium bar and place zirconia over it? And with a bar, mill monolithic zirconia that wraps the bar completely (full contour) or make a separate overlay (the “split iBar” approach)? This article explains how Khai Nguyen chooses between these options, and one step few people notice that decides the success of the case: polishing the bar below the gingiva.

Three constructions for a fixed full arch

A full-contour iBar case in Aidite 3D Pro

In one All-on-X case Khai Nguyen chose a full-contour design: monolithic zirconia milled to enclose the iBar for maximum rigidity and load capacity. To balance esthetics in a monolithic restoration the lab used Aidite 3D Pro, a multilayer zirconia with a smooth gradient from cervical to incisal built into the disc. At the finishing stage the technicians only stained with the Biomic kit and glazed; no layering was needed and the result still had depth. This shortens the process, avoids the chipping risk of layered porcelain on a heavily loaded restoration, and still meets the dentist’s esthetic requirements.

Bar-supported full-arch restoration from the tissue side: the CAD/CAM titanium bar sits inside the zirconia, with screw channels exiting on the tissue side.

Why the bar has to fit passively

On a natural tooth, the periodontal ligament allows several tens of microns of movement, enough to absorb part of a restoration’s discrepancy. An implant integrates directly with bone and has almost none of that capacity. A bar joining several implants therefore has to seat passively: place it and it sits, without tightening screws to draw it into position. If it has to be pulled in, that residual load stays in the system and shows up later as a loosening screw, a fractured screw, or bone loss around the implant.

Accuracy on a bar case does not come from one step but from a chain: recording implant positions by impression or scan, transferring them to the model without distortion, fabricating the bar, then verifying fit before any esthetic work begins. An error at any stage carries into the next, and catching a discrepancy at the bar stage costs far less than finding it after the ceramic is on. The quality of the implant position record therefore drives most of the result: with a conventional impression, splint the impression copings together; with a digital workflow, use scan bodies matched to the system and verify with a confirmation scan.

Digital workflow from bar to overlay

1. Verify implant positions. The model is checked with a verification jig before design. When the impression is taken with intraoral photogrammetry (IPG), the implant positions reach the lab as digital data and this step becomes much shorter.
2. Teeth first, bar second. Teeth are set up from the bite record and facial photos for vertical dimension, midline and lip support, then reduced inward to define a bar that supports every tooth without showing through thin gingiva. Bar and overlay live in the same design file.
3. Mill the titanium bar and test the fit. Single-screw (Sheffield) test on the model; a gap at the opposite end means the bar is not passive and must be remade before the zirconia is milled.
4. Mill the monolithic zirconia from a multilayer disc, sinter, try on the bar; check that the cement space is thin and even.
5. Polish the bar below the gingiva. See the dedicated section below.
6. Esthetic finishing: stain, glaze, layer or stain the gingiva; bond the overlay to the bar following the cement manufacturer’s protocol; remove excess cement.

Bar-supported full-arch case produced through a fully digital workflow: bar and zirconia restoration both designed and milled by CAD/CAM for a stable fit.

The hidden step that decides the case: polishing the bar below the gingiva

With the split iBar approach, the part of the bar under the gingiva and the tissue surface of the restoration are what the patient never sees but touches every day. Titanium or zirconia that is not thoroughly polished there retains plaque, causes peri-implant mucositis and odour, and is a common reason for dissatisfaction even when the teeth above are beautiful. At Khai Nguyen the whole underside of the bar and the junction areas are mirror-polished before the overlay is bonded, and the tissue surface of the overlay is made slightly convex with no dead corners, so floss and interdental brushes pass through.

Photo above: Polishing the titanium bar below the gingiva in a split-iBar All-on-X case: hidden, but decisive for soft-tissue health and patient satisfaction.

Which construction for your case

• Low restorative space (below roughly 12 mm from the multi-unit top to the occlusal plane): a directly screwed zirconia bridge is usually the only feasible option.
• Enough space and a bruxing patient or heavy occlusal load: full contour on an iBar, so titanium takes the load and zirconia only handles esthetics.
• The dentist wants long-term repairability: split iBar, because the overlay can be replaced without removing the bar.
• Long spans on few implants: a titanium bar distributes the load; Khai Nguyen calls this zirconia on I-bar for long-span cases.

Real cases: full-arch Aidite 3D Pro zirconia overlay on a titanium iBar and directly screwed upper and lower All-on-X. Related product: full-arch zirconia bonded on bar. Send a full-arch case via WhatsApp +84 902 945 585.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.

Case fabricated at Khai Nguyen Dental Lab to the treating dentist’s prescription. Photos were taken by the lab and first published on Instagram @khainguyendentallab on 14 June 2025; no patient-identifying information is included. Written for dentists and dental technicians.

Case summary

Photo above: the zirconia crown on tooth 11 after seating, with the gingival margin hugging the cervical contour and matching tooth 21.

What the dentist asked for

An implant at a central incisor is the most demanding single-implant case, because any error in the soft-tissue contour shows immediately in the smile. Here the dentist had shaped the tissue with a provisional during healing and sent the lab a scan with the scan body together with a scan of the provisional. The brief was explicit: the subgingival part of the abutment had to copy the established emergence profile, tissue pressure at the cervical zone had to be exactly 0.5 mm, and the crown on 11 had to match the natural 21 in form, translucency and shade A2.

Why a hybrid abutment and a separate zirconia crown

A hybrid abutment is an individually designed zirconia body bonded to the implant manufacturer’s Ti-base. It lets the lab shape the transmucosal zone freely to the existing profile and gives a tooth-coloured substructure instead of grey metal under thin anterior tissue. The separate zirconia crown is cemented onto the abutment outside the mouth (or intra-orally at the dentist’s choice), so the cement line sits where it can be controlled and the whole assembly remains retrievable through the screw channel.

A multilayer 3M Lava disc was chosen because the crown needed enough opacity to mask the Ti-base and screw channel while keeping incisal translucency to blend with tooth 21. See 3Y-TZP vs 5Y-PSZ zirconia for how discs are selected.

The custom hybrid abutment: zirconia body on a Ti-base, with the transmucosal zone designed to the tissue profile shaped by the dentist.

Lab workflow

1. Merging the digital data. The scan with the scan body, the scan of the provisional and the opposing scan were aligned in the design software to capture the implant position and the existing gingival contour.
2. Abutment design. The transmucosal zone copied the provisional, then was enlarged uniformly by 0.5 mm at the cervical zone as prescribed to apply light tissue pressure so the margin would close tightly on seating. The screw-channel axis was checked to exit palatally.
3. Crown design. Tooth 11 was built as a mirror of the natural 21 in width, outline and labial contour, with small deliberate differences so the two incisors would not look identical.
4. Production and checks. Abutment and crown were milled from the Lava disc, sintered, the zirconia body bonded to the Ti-base, then stained and polished. The assembly was checked on a model with a removable soft-tissue mask for the emergence contour, occlusion and proximal contacts.

Zirconia crown on the hybrid abutment tried on the model with the soft-tissue mask to check emergence and contacts with the neighbouring teeth.

Result

The post-seating photo shows the gingival margin of tooth 11 level with tooth 21, full papillae on both sides with no black triangles, and no grey show-through at the cervical area. Form, incisal translucency and shade A2 blend with the adjacent incisor. The intra-oral photo at abutment placement shows the soft tissue closing around the transmucosal zone without blanching, confirming that 0.5 mm of pressure was appropriate.

Lessons for similar cases

• Send the scan of the provisional together with the scan-body scan. Without the established profile the lab can only design the transmucosal zone to a default geometry, and the tissue outcome becomes unpredictable.
• State the desired tissue pressure (0.3, 0.5 or 0.8 mm) instead of “snug”; every clinician has a different habit and the lab should not decide this alone.
• Photograph the adjacent teeth with a shade tab so the lab picks a multilayer disc of the right opacity and reproduces the enamel character of tooth 21 on tooth 11.

See the implant restorations we produce, or send a case via WhatsApp +84 902 945 585.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.

Case fabricated at Khai Nguyen Dental Lab to the treating dentist’s prescription. Photos were taken by the lab and first published on Instagram @khainguyendentallab on 29 May 2025; no patient-identifying information is included. Written for dentists and dental technicians.

Case summary

Photo above: frontal view of the full-arch restoration, multilayer zirconia teeth with pink ceramic gingiva showing papillae and a colour gradient.

What the dentist asked for

The patient was fully edentulous in the arch and had implants placed. The dentist chose a CAD/CAM-milled titanium bar screwed to the implants with a full-arch zirconia overlay bonded onto it. Compared with a monolithic zirconia bridge screwed directly to the implants, this construction separates the load-bearing function (titanium bar) from the esthetic function (zirconia overlay), reduces the risk of zirconia fracture around screw channels, and allows the overlay to be replaced later without touching the bar. The requirements were passive fit on the implants, individual tooth anatomy with natural translucency, and realistic ceramic gingiva.

What the lab had to control

With a bar-and-overlay system two fits must be right: the bar must seat passively on the implants, and the overlay must fit the bar so the bonding cement layer is thin and even. Both are designed in the same file. The lab set up the teeth in their esthetic position first, then reduced the arch inward to define a bar that supports every tooth without showing through in areas of thin gingiva. The bar was milled from titanium; the overlay from an Aidite 3D Pro multilayer disc so the cervical zone is opaque and the incisal zone more translucent straight from the disc.

Tissue side of the restoration: the CAD/CAM titanium iBar sits fully inside the zirconia overlay, with the screw channels exiting on the tissue side.

Lab workflow

1. Model verification. Implant positions on the model were confirmed with a verification jig before design, because any error here becomes a fit error in the bar.
2. Teeth and bar designed together. Tooth set-up from the bite record and facial photos for vertical dimension, midline and lip support; the bar designed inside with the minimum overlay thickness respected everywhere.
3. Milling and bar try-in. The titanium bar was milled and its passive fit checked on the model with a single-screw test; the zirconia overlay was milled and sintered.
4. Esthetic finishing. Layered staining of the teeth, surface texture, pink ceramics in several shades with papillae, then firing and polishing.
5. Bonding the overlay to the bar following the cement manufacturer’s protocol, removing excess cement on the tissue side and polishing the tissue-contact surface for hygiene.

Lateral view: posterior teeth with individual anatomy, and ceramic gingiva grading from the cervical margin to the vestibular base.

Result

The photos on the model show the zirconia overlay enclosing the bar completely, with the bar visible only on the tissue side at the screw channels. Anterior teeth show incisal translucency, posterior teeth have defined cusps and grooves, and the ceramic gingiva has full papillae and a natural colour gradient. The junction between zirconia and pink ceramic is continuous, without a step.

Lessons for similar cases

• Always send a verification jig or ask the lab to make one for an intra-oral check before the bar is milled; it is the cheapest way to avoid remaking a titanium bar.
• Agree screw-channel positions and overlay thickness in the anterior segment in advance, because the distance from implant to incisal edge decides whether the overlay is thick enough to be translucent.
• Select the gingival shade with a gingiva shade guide from the start; with this much pink ceramic, correcting the gingival shade after bonding is very difficult.

Compare with the All-on-X case screwed directly to multi-unit abutments, or send a full-arch case via WhatsApp +84 902 945 585.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.

Case fabricated at Khai Nguyen Dental Lab to the treating dentist’s prescription. Photos were taken by the lab on the model and first published on Instagram @khainguyendentallab on 23 June 2026; no patient-identifying information is included. Written for dentists and dental technicians.

Case summary

Photo above: Both full-arch bridges on the model with the multi-unit abutments visible above and below; the ceramic gingiva shows a natural margin, papillae and colour gradient.

What the dentist asked for

The patient was fully edentulous in both arches and had been rehabilitated with implants under an All-on-X protocol. The dentist requested two fixed full-arch bridges with three priorities: the artificial gingiva had to have realistic form (papillae, cervical contour, varying thickness from anterior to posterior), each tooth had to carry its own anatomy rather than a row of identical teeth, and the occlusion of both arches had to be set up together because both restorations were new.

What the lab had to control

In full-arch work three factors decide the outcome: tooth position relative to the face, vertical dimension, and passive fit of the framework on the multi-unit abutments. The lab received models, bite records and facial photos from the dentist, designed the teeth digitally to check midline, smile line and occlusal plane, and only then went into production. Passive fit was verified on the model with a single-screw (Sheffield) test before the ceramic work was completed.

The gingival portion is often underestimated, yet it decides whether the restoration looks natural in a wide smile. The ceramist layered the pink ceramic in several shades: deeper pink at the vestibular base, lighter at the cervical margin, small darker accents imitating vasculature, and full papillae between the anterior teeth to avoid black triangles.

Lab workflow

1. Model and abutment check. Positions of the multi-unit abutments on the model were compared with the scan data, and parallelism and spacing were checked so screw access could be placed occlusally or palatally.
2. Digital design of both arches together. Vertical dimension, midline, lip support, tooth arrangement with individual anatomy per position, and canine guidance were set in the design.
3. Framework and teeth. The frameworks were milled and checked for passive fit, then the teeth and pink ceramic were finished to the colour map agreed with the dentist.
4. Final check. Both arches were tried in on the model, static and excursive occlusion checked, the tissue surface polished for hygiene, and the case photographed before shipping.

Timing for full-arch cases is agreed per case and normally includes one try-in before finishing. See the ordering process for how to prepare an implant case file.

Result

The photos on the model show two full-arch bridges with individually shaped teeth, incisal translucency on the anterior units, and a gingival surface with full papillae and a natural colour gradient from the cervical margin to the vestibular base. The multi-unit abutments visible on the tissue side show the frameworks seated fully on the model.

Lessons for similar cases

• Send frontal and lateral smiling facial photos with the models so the lab positions the teeth to the face, not only to the ridge.
• Agree the gingival shade with a gingiva shade guide or photos of the patient’s natural gingiva under neutral light; a wrong gingival shade is more visible than a wrong tooth shade.
• Plan one try-in. With two completely new arches, a try-in confirms vertical dimension and phonetics before finishing and greatly reduces the risk of a full remake.

Related reading: outsourcing implant work to Khai Nguyen, or message WhatsApp +84 902 945 585.

Written for dentists and technicians. Khai Nguyen Dental Lab manufactures to clinical prescription only and does not sell directly to patients.