While complete-arch digital-implant-scanning protocols have been described, their clinical outcomes when using polymethyl methacrylate (PMMA) as a provisional material remain insufficiently substantiated. This clinical study aims to integrate digital solutions into implant dentistry and establish PMMA as a reliable material for immediate-loaded protocols. Fifty-six patients received 432 implants and 72 immediate fixed interim complete-arch prostheses, all fabricated using a fully digital workflow. Patients were followed up at 3 months to evaluate implant survival, prosthesis survival, and implant mean marginal bone loss using an interim PMMA prosthesis. Patients completed the Oral Health Impact Profile (OHIP) questionnaire to determine the implants’ impact on quality of life. Statistical analyses included analysis of variance, Fisher’s least significant difference (LSD) test, and the Wilcoxon signed-rank test. Of the 432 implants placed, only two failures were observed. Marginal bone loss (MBL) was significantly greater in male patients (p = 0.002) and older smokers (p = 0.016). Patient-reported outcomes, as measured by the OHIP questionnaire, demonstrated significant improvements in quality of life. PMMA is a reliable material for immediate-loading protocols in fixed interim complete-arch implant prostheses. Its combination of mechanical strength, biocompatibility, and esthetic properties, along with the accuracy of fully digital workflows, ensures predictable clinical outcomes.

A clinically unresolved question in full-arch implant rehabilitation is whether early peri-implant bone adaptation is primarily a local (implant-level) phenomenon, a shared within-arch response, or a patient-level characteristic—information is unavailable from conventional mean-based outcome reporting. This prospective secondary analysis quantified the hierarchical distribution of peri-implant marginal bone level change (ΔMBL) in monolithic zirconia full-arch prostheses directly connected to multi-unit abutments during the first year of function. Unlike mean-based endpoints, this approach identifies whether early bone adaptation variability originates primarily at the implant, prosthetic-arch, or patient level. Of 308 implants placed in 40 completely edentulous patients rehabilitated with 49 prostheses, 2 implants failed before delivery of the definitive prosthesis and were excluded from radiographic analysis, leaving 306 implants available for multilevel analysis. Implant-level ΔMBL was analyzed using an unconditional three-level linear mixed-effects model. Implant survival was 99.2%, prosthetic survival was 100%, and mean ΔMBL at 12 months was 0.38 ± 0.27 mm. Variance partitioning showed that 60.8% of total variability occurred at the implant level, 28.4% occurred at the patient level, and 10.8% occurred at the prosthetic-arch level, providing a framework for identifying at which level of the restorative system future clinical interventions may have the greatest impact. Findings should be interpreted within the context of a secondary analysis with a 12-month follow-up and no explanatory covariates; longer-term comparative studies with explanatory multilevel designs are required to confirm and extend these observations.

Whether arch-specific anatomical configuration affects early peri-implant bone behavior in monolithic zirconia full-arch prostheses is unclear. This prospective cohort study evaluated 40 edentulous patients with 49 monolithic zirconia full-arch prostheses (25 maxillary, 24 mandibular; 308 implants). MBR and patient-reported outcomes were recorded at baseline and 12 months; mandibular morphology (U- vs. V-shaped) was classified on CBCT, and inter-implant distance and cantilever length were measured on CAD designs. Because 9 of 40 patients contributed both arches, the primary MBR comparison used a linear mixed-effects model; morphology and geometry associations were exploratory (ANOVA; Pearson correlation). Implant and prosthetic survival were 99.4% and 97.9%. Mean MBR was higher in the mandibular (0.86 ± 0.06 mm) than the maxillary arches (0.73 ± 0.02 mm); the mixed-effects model estimated this difference as β = 0.13 mm (95% CI: 0.10–0.16; p < 0.001). V-shaped mandibles (0.91 ± 0.04 mm) showed higher MBR than U-shaped mandibles (0.81 ± 0.04 mm; mean difference 0.10 mm; p < 0.001), and inter-implant distance correlated negatively with MBR in the mandible (r = −0.70, p < 0.001) but not in the maxilla (r = 0.01, p = 0.97). Patient-reported outcomes improved markedly in both arches; two minor chipping events occurred, both in V-shaped mandibles. Monolithic zirconia full-arch prostheses showed favorable short-term outcomes in both arches. Arch- and mandibular-morphology-related differences in early MBR were statistically robust and highly consistent in standardized effect size, although the absolute differences were numerically modest; these findings suggest an association between anatomical configuration and early bone remodeling under rigid, full-arch monolithic zirconia frameworks that warrants further confirmation.