#Implantology 20. May 2026

True purpose: The story and clinical case report of Dr. Gustavo Harfagar

Driven by a vision to bring high-quality dentistry closer to people, Dr. Gustavo Harfagar made a bold move - leaving the capital of Santiago de Chile to establish his practice in a small coastal town. Far from large referral centers, he faced a critical question: how to maintain the same level of advanced care, efficiency, and predictability in a remote setting. This case illustrates why partnering with a reliable and fully integrated system like Straumann becomes essential. Through the rehabilitation of a 62-year-old patient with severe functional and esthetic challenges, Dr. Harfagar demonstrates how a connected digital workflow can deliver life-changing results - restoring not only oral health, but confidence and quality of life - even in the most remote environments. Discover how this journey unfolds in the full case and watch the video to see how innovation, trust, and clinical expertise come together to transform patient outcomes.

Gustavo Harfagar

Straumann iEXCEL™ Performance System: Bimaxillary full-arch rehabilitation with the Straumann digital ecosystem

What is this about?

This article explores how a coordinated digital workflow was used to rehabilitate a bimaxillary full-arch case, combining facially driven planning, guided surgery, immediate loading, and restorative continuity within the Straumann ecosystem.

  • Full-arch rehabilitation in a patient with severely compromised remaining dentition, unstable removable prosthetic function, and significant esthetic and psychosocial burden.
  • Facially driven digital smile design with Smilecloud to define the restorative endpoint before surgery.
  • Integration of Straumann SIRIOS™ X3, Smilecloud, coDiagnostiX®, Straumann AXS™, and the Straumann iEXCEL™ Performance System in one connected workflow.
  • Guided implant placement and immediate loading with Straumann TLX™ implants in both arches.
  • Secondary digital capture for definitive bimaxillary zirconia restorations with an outcome closely reflecting the original smile design.

Résumé

This clinical case report presents the rehabilitation of a 62-year-old male patient with multiple missing teeth, poor oral hygiene, mobility of the remaining dentition, and a continuously unstable removable partial prosthesis. Beyond the clinical deterioration, the patient reported major difficulties eating and speaking, together with a profound loss of confidence in his appearance. The case was managed in a small coastal town in Chile, showing that a highly coordinated digital workflow can bring advanced full-arch care to locations far from large referral centers.

The treatment was structured around a connected Straumann digital workflow. Smilecloud was used to define the intended restorative endpoint from the beginning, while the Straumann SIRIOS™ X3, Straumann AXS™, and coDiagnostiX® supported digital recording, planning continuity, and guided execution. Six Straumann TLX™ implants were placed in the maxilla and four in the mandible, followed by immediate loading with PMMA provisional prostheses. After healing, secondary digital capture was performed with the Straumann SIRIOS™ X3 full-arch protocol, and the definitive bimaxillary zirconia prostheses were fabricated and delivered.

This case highlights how a prosthetically driven digital strategy can reduce inefficiencies, create and strengthen communication between clinic and laboratory, and maintain remarkable consistency between the planned smile and the final restoration. Most importantly, it illustrates how the combination of guided surgery, immediate loading, and digital restorative continuity translated into a meaningful improvement in function, esthetics, self-image, and quality of life for the patient, far from big cities, bringing high-quality dentistry to a remote corner of the world.

Introduction

Full-arch rehabilitation in patients with severely compromised remaining dentition is one of the most demanding areas in oral rehabilitation. The challenge is not limited to replacing teeth. It also involves restoring stability, speech, function, facial support, and confidence, often in patients who have already experienced years of discomfort, repeated restorative failure, and diminished quality of life (1,2). In such cases, reducing the number of appointments while maintaining precision and coordination becomes especially valuable.

Digital workflows are increasingly reshaping this landscape by improving interdisciplinary communication, enhancing continuity from diagnosis to restoration, and supporting greater precision and predictability in implant treatment and complete-arch restorative workflows (3,4). Straumann positions the intraoral scanner Straumann SIRIOS™ X3 as the gateway to its integrated digital ecosystem, enabling precise intraoral data acquisition and intended to support efficient, accurate digital workflows, particularly in full-arch and complex cases. It provides direct workflow continuity into Straumann AXS™ and coDiagnostiX®. Within that ecosystem, Smilecloud serves as a facially driven smile design and collaboration platform, allowing the restorative endpoint to be visualized early and shared with both the patient and the laboratory team.

For implant planning and surgical execution, coDiagnostiX® supports prosthetically driven planning and guided procedures, while the Straumann TLX™ implant system and Straumann iEXCEL™ Performance System are designed to support immediate protocols, digital connectivity, and efficient restorative workflows. Long-term evidence supporting SLActive®-based immediate and early loading, together with clinical analyses of immediately loaded fixed full-arch prostheses, reinforces the rationale for accelerated fixed protocols when sufficient primary stability can be achieved (5,6). In addition, the Ti-15Zr alloy used in Roxolid® implants has demonstrated favorable mechanical properties relevant to reduced invasiveness and demanding clinical situations (7).

This clinical report describes how that connected digital strategy was applied in a small coastal town in Chile to rehabilitate a 62-year-old patient with hopeless residual dentition. More than a demonstration of tools, the case illustrates how a coordinated workflow can transform complex treatment into a structured, predictable, and emotionally meaningful clinical experience.

Initial situation

Patient background

A 62-year-old male patient presented to the clinic with multiple missing teeth, poor dental hygiene, and a removable partial prosthesis that had become increasingly unstable. He described ongoing difficulty eating and speaking because the prosthesis moved continuously during function. Just as important, he reported a severe impact on self-esteem and social confidence, as his oral condition no longer reflected how he wanted to live or present himself.

The patient had no systemic diseases and was a non-smoker. Nevertheless, the remaining dentition showed generalized mobility, heavy plaque accumulation, and diffuse soft tissue inflammation. Clinical and radiographic analyses confirmed that all remaining teeth and roots had a hopeless prognosis, together with significant bone loss in the posterior maxilla and an irregular mandibular ridge.

Clinical Findings

Clinical examination revealed generalized mobility of the remaining teeth, abundant plaque accumulation, and inflammation affecting the soft tissues around the entire dentition. The residual teeth were severely compromised, both structurally and periodontally, and could not support a stable long-term rehabilitative strategy.

From a prosthetic standpoint, the patient’s removable partial prosthesis was no longer providing acceptable retention, support, or comfort. This instability directly contributed to his functional limitations and reinforced the need for a fixed, comprehensive solution.

Radiographic evaluation

Tomographic analyses confirmed that all remaining teeth and roots were hopeless, with no sites that justified a conservative restorative approach. The upper posterior regions showed marked bone loss, while the mandibular ridge presented an irregular anatomy that would need to be respected and strategically managed during implant planning.

Taken together, these findings pointed decisively toward full-mouth extraction followed by implant-based full-arch rehabilitation. The remaining question was not whether the patient needed a definitive full-arch solution, but how to structure it in the most precise, efficient, and patient-centered way.

Treatment planning

Treatment planning began with the definition of the intended restorative outcome rather than the surgical intervention itself. To establish a facially driven endpoint, Smilecloud was incorporated as a digital smile design and restorative visualization step, allowing the team to project the final restorations according to the patient’s facial features and esthetic expectations. This digital preview helped define key parameters such as tooth display, smile arc, midline orientation, incisal position, and overall dentogingival balance. By visualizing the desired outcome in advance, the surgical and restorative strategy could then be developed in a fully prosthetically driven manner.

Extraoral and intraoral photographs were captured, and digital records were obtained with the intraoral scanner Straumann SIRIOS™ X3. The use of the scanner at this stage was not limited to data acquisition alone; it also served as the digital gateway for workflow continuity, allowing information to remain available for planning, communication, and restorative coordination within the Straumann ecosystem.

A lateral cephalometric radiograph was additionally obtained to study the vertical dimension of occlusion (VDO) and determine a new target within accepted clinical parameters.

Before surgery, full-mouth periodontal treatment was performed to reduce inflammation of the surrounding soft tissues. The patient was instructed to rinse with 0.012% chlorhexidine twice daily for 14 days to improve the condition of the tissues before extractions and implant placement. Once the soft tissues were stabilized, the Smilecloud design was exported as a blueprint STL to serve as the basis for a digital wax-up in exocad, ensuring continuity between facial analysis, restorative planning, and laboratory execution.

The implant strategy was then defined in coDiagnostiX® as a guided, prosthetically driven full-arch rehabilitation. The plan called for extraction of the remaining teeth, placement of six Straumann TLX™ 3.75 x 10mm RT implants in the maxilla and four Straumann TLX™ 3.75 x 8mm RT implants in the mandible, localized grafting of extraction sockets with botiss cerabone®, and immediate loading with upper and lower PMMA provisional prostheses supported by Straumann® Variobase®  RT components for bridge abutments.

This sequence reflected the central logic of the case: begin with the final smile, translate that vision into a guided surgical plan, deliver fixed provisional teeth immediately, and preserve digital continuity until the definitive restorations. In a remote setting, this level of coordination was particularly important, because it reduced inefficiencies, minimized the number of visits, and increased confidence for both the patient and the clinical team.

This case showed how a well-orchestrated digital workflow can make advanced full-arch rehabilitation feasible far beyond large referral centers. By connecting scanning, smile design, guided planning, and restorative execution within one coordinated process, the treatment became more efficient, more predictable, and easier to manage for both the clinical team and the laboratory. Straumann’s digital ecosystem allows us to use digital tools to bring oral health and high-quality solutions to a remote location.

Gustavo Harfagar

Surgical procedure

According to the clinician’s protocol, preoperative antibiotic prophylaxis with amoxicillin 1 g was initiated two days before surgery and maintained for a total of seven days. Local anesthesia was administered in the palatal and upper vestibular areas, together with troncular anesthesia for the lower arch.

The maxillary surgical phase was performed first. After extraction of the remaining teeth, the surgical guide was positioned and six Straumann TLX™ implants were placed. Bone grafting with botiss cerabone® was limited to the extraction sites. cerabone® is a deproteinized bovine bone mineral grafting material intended to provide dimensionally stable structural support in ridge preservation (8). The mandibular phase followed the same logic: the remaining teeth were extracted, an alveolar ridge recontouring procedure was carried out, the guide was placed, and four Straumann TLX™ implants were inserted. Again, grafting was restricted to the extraction sockets.

Guided surgery served as the clinical bridge between digital planning and implant placement. Implant positioning was planned digitally in coDiagnostiX® according to the intended restorative outcome, and this information was transferred to the surgical phase through the Straumann iGuide™ workflow. The combination of digitally designed guidance, a dedicated guided instrument system, and the simplified logic of the Straumann iEXCEL™ environment helped maintain continuity from planning to placement, supporting a prosthetically driven and efficient surgical execution.

Ten Straumann® RT temporary abutments for bridges were then installed, and 4-0 nylon sutures were placed. Based on the preoperative digital records acquired with Straumann SIRIOS™ X3, the Smilecloud design, and the prosthetically driven surgical plan, upper and lower CAD/CAM provisional prostheses in multilayer PMMA had been prepared in advance for immediate delivery. Once implant placements had been completed, these restorations were connected chairside to the temporary restorative components, translating the digital treatment plan into fixed teeth on the same day of surgery. This immediate provisional phase preserved continuity between digital planning, guided surgery, and restorative execution, allowing the patient to leave the clinic with immediate functional and esthetic rehabilitation. Analgesics and anti-inflammatory medication were prescribed for four days, and the first follow-up visit was scheduled for seven days after surgery.

From a clinical standpoint, the procedure was guided by the same principle that shaped the planning stage: keep the surgical act aligned with the intended restorative result. This ensured that the surgery was not an isolated event, but a direct translation of the approved digital design into the patient’s mouth.

Prosthetic procedure

Follow-up visits were carried out every four weeks over a total period of 16 weeks. At the end of this healing phase, a panoramic radiograph was obtained, and the patient was prepared for the definitive restorative stage.

Data acquisition for the final prostheses was performed with the intraoral scanner Straumann SIRIOS™ X3 full-arch protocol, which allowed capture of implant-related positions, soft tissue contours, and the existing PMMA provisional restorations in a structured and highly controlled manner. For the scanbody acquisition step, RT scanbodies were installed directly into the Straumann TLX™ implants, and Medentika® MedentiWINGS were attached with flowable resin to support stable digital registration.

The full-arch protocol was followed step by step, starting from the occlusal aspect of the scanbodies and continuing until the digital capture of both arches was complete. Attention was paid to scanbody alignment, soft tissue recording, and intaglio acquisition, as these steps were critical to reducing stitching errors and preserving the relationship between the provisional restoration and the definitive design phase.

All digital records, together with the original Smilecloud design, were then transferred to the laboratory for fabrication of the upper and lower zirconia prostheses. A major strength of this workflow was that the Smilecloud design file, exported as STL, maintained its 3D positional relationship with the intraoral PLY/STL files. This allowed the laboratory technician to import the design into CAD software such as exocad and use it as a digital wax-up reference, so that what had been shown to the patient at the planning stage could be reproduced in the definitive restorations with a high degree of fidelity.

For the definitive phase, a full-arch zirconia restoration was selected for its favorable combination of strength, durability, and esthetic integration. Within the Straumann digital ecosystem, the restorative workflow can progress from facially driven design in Smilecloud to digital data acquisition with Straumann SIRIOS™ X3 and connected planning through Straumann AXS™ and coDiagnostiX®, supporting efficient laboratory collaboration and a predictable transfer from digital design to final full-arch restoration.

After final installation, follow-up visits were scheduled at one week, one month, and three months. By that point, the restorative workflow had completed a full digital loop, from the initial facially driven smile design to the definitive bimaxillary zirconia rehabilitation.

Treatment outcomes

The immediate loading protocol had a profound effect on the patient from the very first day. He was able to speak and eat more comfortably immediately after surgery, but the benefits extended far beyond function alone. The transition from an unstable removable prosthesis to fixed immediate restorations gave him back a sense of security that had been missing for a long time.

Over time, the patient’s transformation became even more evident. He began to take better care of his appearance, lost weight, adopted a more balanced diet, and regained confidence in his social life. The definitive zirconia prostheses further reinforced that change, providing a stable and highly integrated final result that strengthened his trust in both the treatment and the materials used.

An especially important outcome in this case was the consistency between the projected and the delivered smile. The Smilecloud design was not merely a communication tool; it became a visual and restorative reference throughout the case. As a result, the definitive restorations closely reflected the original projection, which significantly contributed to patient satisfaction. In that sense, the result was not only clinically successful. It also felt familiar, expected, and emotionally validating to the patient because he could recognize, in the definitive prostheses, the smile that had been envisioned from the beginning. This case therefore demonstrates that the value of a connected digital workflow is not restricted to efficiency or precision. It also lies in its ability to make complex treatment more understandable for the patient and more reproducible for the team, culminating in a result that is both technically reliable and deeply meaningful wherever the clinic may be on the globe.

Key takeaways

  • A connected digital workflow can make bimaxillary full-arch rehabilitation more predictable and more efficient, even outside major referral centers.
  • Smilecloud helped define the restorative endpoint before surgery and improved both patient communication and laboratory alignment.
  • Straumann SIRIOS™ X3 supported precise digital data acquisition at both the diagnostic and definitive stages of the case.
  • coDiagnostiX® enabled prosthetically driven planning and guided surgery within a broader restorative strategy.
  • Straumann TLX™ implants and the Straumann iEXCEL™ Performance System supported an immediate protocol that combined guided surgical simplicity with restorative continuity.
  • The final zirconia restorations closely reflected the original digital design, contributing to a strong functional, esthetic, and emotional outcome. 
References
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  2. Srinivasan M, Kamnoedboon P, Angst L, Müller F. Oral function in completely edentulous patients rehabilitated with implant-supported dental prostheses: A systematic review and meta-analysis. Clin Oral Implants Res. 2023;34 Suppl 26:196-239.
  3. Blatz MB, Coachman C. The Complete Digital Workflow in Implant Dentistry. Compend Contin Educ Dent. 2023;44(7):416.
  4. Wulfman C, et al. Digital scanning for complete-arch implant-supported restorations: A systematic review. J Prosthet Dent. 2020;124(2):161-167.
  5. Nicolau P, Guerra F, Reis R, Krafft T, Benz K, Jackowski J. 10-year outcomes with immediate and early loaded implants with a chemically modified SLA surface. Quintessence Int. 2019;50(2):114-124.
  6. Eckert SE, Hueler G, Sandler N, Elkattah R, McNeil DC. Immediately Loaded Fixed Full-Arch Implant-Retained Prosthesis: Clinical Analysis When Using a Moderate Insertion Torque. Int J Oral Maxillofac Implants. 2019;34(3):737-744.
  7. Medvedev AE, Molotnikov A, Lapovok RY, Zeller R, Berner S, Habersetzer P, Dalla Torre FH. Microstructure and mechanical properties of Ti-15Zr alloy used as dental implant material. J Mech Behav Biomed Mater. 2016;62:384-398.
  8. Nart J, Barallat L, Jimenez D, Mestres J, Gómez A, Carrasco MA, Violant D, Ruíz-Magaz V. Radiographic and histological evaluation of deproteinized bovine bone mineral vs. deproteinized bovine bone mineral with 10% collagen in ridge preservation. A randomized controlled clinical trial. Clin Oral Implants Res. 2017;28(7):840-848.