An accurate image registration of the optical scan of a completely edentulous ridge to radiographic data remains challenging due to the absence of natural teeth. This article introduces a radiopaque tissue surface-based digital registration technique that enhances the accuracy of the image matching process and improves the fit accuracy of the implant surgical guide. In this workflow, a radiopaque impression body that is the replica of the edentulous ridge was used as a surface-based fiducial marker for accurate image registration between the soft and hard tissues of a completely edentulous arch. A virtual edentulous model was generated by direct digitization of the impression body and a digital image reversal technique without the need for stone cast fabrication or additional intraoral scanning. The fabricated surgical guide showed close adaptation to the edentulous ridge of the patient.

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