Full Digital Rehabilitation of a Complex Partially Edentulous Patient via Toronto Prosthesis: A Case Report

Abstract

This case report describes the oral rehabilitation of a complex partially edentulous patient with malpositioned teeth and implants using a full digital workflow and hybrid prosthesis design. A 55-year-old male patient presented with pain, oral hygiene, aesthetic, and functional complaints. Following extraction of teeth 26, 27, and 47, five endosseous dental implants were placed in regions 24, 26, 36, 46, and 47. Due to advanced hard and soft tissue loss and the patient's refusal of additional augmentation, implants in the 24–27 region were placed in a buccal-apical malposition despite guided tissue regeneration. After osseointegration, full-arch fixed partial dentures (FPDs) were planned for both jaws. Intraoral scanning, CBCT data, and pre/postoperative photographic records were integrated into the digital design workflow. Tooth-supported FPDs were designed as monolithic restorations; mandibular implant-supported FPDs (ISFPDs) as screw-retained monolithic; and maxillary ISFPDs as a hybrid Toronto Bridge design comprising a screw-retained zirconia substructure with a cement-retained monolithic superstructure. All restorations were fabricated from hybrid-composition multilayer monolithic zirconia blocks (3–5Y-PSZ) via CAD/CAM subtractive manufacturing. Try-in temporary restorations were evaluated for marginal fit, occlusion, and esthetics prior to final delivery. Digital workflow applications integrating intraoral scanning and photographic guidance are effective for achieving predictable aesthetic and functional outcomes in complex rehabilitations with malpositioned implants. The Toronto Bridge hybrid design successfully compensates for implant malposition, and hybrid-composition multilayer monolithic zirconia provides clinically reliable esthetic and mechanical results.