A Digital Stackable Guide Protocol for FP1 Full-Arch Esthetic Reconstruction With Monolithic Zirconia.

OBJECTIVE: To describe a fully digital and stackable surgical guide workflow for full-arch rehabilitation in a patient with advanced periodontitis, aiming to restore esthetics, function, and biological stability with a monolithic zirconia prosthesis. CLINICAL CONSIDERATIONS: A 38-year-old female presented with excessive gingival display and tooth mobility associated with Stage III, Grade C periodontitis. After periodontal stabilization, a digital workflow integrating CBCT and intraoral scans was implemented using CoDiagnostiX software. A four-stage stackable guide system enabled precise anchor pin placement, bone reduction, and implant positioning for a six-implant ("All-on-Six") immediate-loading protocol. A prefabricated PMMA provisional prosthesis was delivered at surgery. At 5 months, a connective tissue graft refined soft tissue contours, and at 6 months, a definitive two-piece monolithic zirconia prosthesis was delivered, achieving excellent gingival integration, occlusal balance, and esthetic harmony. CONCLUSION: A digitally guided, stackable workflow allows accurate bone reduction, prosthetically driven implant positioning, and predictable esthetic outcomes in complex full-arch rehabilitations following periodontitis. CLINICAL SIGNIFICANCE: Integrating stackable guide technology with monolithic zirconia restorations enhances surgical precision, minimizes intraoperative variability, and ensures long-term esthetic and functional stability in full-arch implant rehabilitations.