Digitally Guided Full-Arch Immediate Implant Rehabilitation with an FP1 Restoration
Dr Alex Payne restores a dentally anxious patient’s lower dentition with same day results.
Introduction
A considerable proportion (over 15%) of the global population has dental fear and anxiety.[i] This is a multifactorial issue that impacts an individual’s access to dental care and, therefore, their oral health.[ii] It is vital for professionals to acknowledge and manage dental fear to ensure that patients can complete the treatment they need. The literature suggests several strategies to consider, from distraction therapy to hypnosis, acupuncture, and virtual reality.[iii]
In some situations, dental anxiety can be improved with clear communication from the practitioner and fewer treatment steps. Immediate implantology offers a solution, enabling restoration of oral function and aesthetics in a single surgery, when appropriate. The case below details a patient’s preference for immediacy to help overcome her dental fear.
Patient presentation
A 60-year-old female patient presented with significant dental anxiety and treatment phobia. Her chief complaint was the repeated debonding of an existing upper left bridge in the UL1–3 region. She reported that the bridge frequently became dislodged and that she had been re-cementing it daily using over-the-counter temporary dental cement. The situation was causing significant frustration and functional difficulty.
The patient was also aware that several other teeth had previously fractured or required extraction and expressed concern regarding the long-term prognosis of her remaining dentition.
Clinical examination and diagnosis
Following the removal of the existing bridge, the retained roots beneath the abutments were found to be unrestorable due to extensive caries extending subgingivally. Additional unrestorable retained roots were present at UR5, UR6 and UL6.
Among the remaining teeth, UL5 and UR4 were heavily restored with large amalgam restorations and exhibited associated periapical pathology.
At this stage, the only maxillary teeth considered to have a favourable long-term prognosis were UR1, UR3, UR7 and UL7, although the condition of UR1 and UR3 remained uncertain due to the previously existing bridge.
Fig 1: Patient presentation
Fig 2: Pre-treatment intraoral view
Fig 3: Pre-treatment upper occlusal view
Fig 4: Digital planning of implant ideal positioning
Treatment planning
A detailed discussion was undertaken with the patient regarding possible treatment options. It may have been possible to retain any remaining teeth with a favourable prognosis and place implants between them to restore the missing sites. The alternative was extraction of the remaining maxillary teeth and rehabilitation with a full-arch implant-supported restoration.
Due to the patient’s significant dental anxiety, she expressed a preference to complete as much treatment as possible in a single stage. A full-arch implant solution was therefore selected.
The prosthetic design was discussed in relation to FP1 and FP3 restorative concepts. As the patient presented with favourable bone levels, good existing arch architecture and a thick soft tissue biotype, an FP1 restoration was considered appropriate. The patient’s tooth loss was not associated with poor oral hygiene, and therefore the proposed FP1 restoration was considered maintainable long-term.
Restorative treatment was also planned for the mandibular arch to improve occlusion and aesthetics.
Implant selection
CONELOG® Progressive-Line implants (Camlog) were selected due to their predictable primary stability, which is important for immediate loading protocols. The conical implant-abutment connection provides a stable restorative interface, and the COMFOUR multi-unit abutment system (Camlog) offers a slim emergence profile that is well suited to FP1 restorations.
This design allows implants to be placed slightly subcrestally while maintaining favourable prosthetic contours. In posterior regions, the larger 5.0 multi-unit abutments provide an improved emergence profile without the need to position implants excessively deep.
The SLA Promote® surface and grade 4 titanium composition also provides reliable and predictable osseointegration.
Fig 5: Failing dentition atraumatically extracted
Fig 6: Surgical guide fitted in the mouth
Fig 7: Implants placed through surgical guide to ensure positioning precision
Fig 8: Occlusal view of implants placed, immediately post-operative
Surgical procedure
A total of eight implants were placed in positions corresponding to those shown in the clinical imaging. All implants were placed in a prosthetically guided manner so that straight multi-unit abutments could be used.
All implants achieved insertion torque values exceeding 35 Ncm, allowing immediate loading.
MinerOss® Putty (BioHorizons) was used to graft the residual gaps and preserve the pontic sites. This material was selected due to its ease of handling and its collagen-containing 100% allograft composition, which provides structural support during healing while gradually resorbing.
Although soft tissue grafting is commonly performed in full-arch immediate cases, this patient presented with favourable tissue architecture and a thick biotype. For this reason, additional soft tissue grafting was not performed.
Immediate provisionalisation
Following surgery, an intraoral scan was taken using a Medit i700 scanner with PEEK scan bodies.
Prior to surgery, the brilliant Smile Design Laboratory had already designed the majority of the provisional restoration based on the digital wax-up. Using the post-operative scan data, the FP1 provisional restoration was finalised and milled in graphene.
The provisional bridge was delivered a few hours after surgery and fixed directly to the multi-unit abutments using Rosen screws. The restoration was screw-retained and demonstrated a passive fit on first insertion.
Healing and review
At the one-week review appointment, soft tissue healing was excellent and the patient reported minimal post-operative discomfort.
Healing progressed uneventfully and at three months the soft tissue architecture was stable with well-integrated peri-implant tissues. The patient was very satisfied with the aesthetic and functional outcome.
During the healing period, the planned restorative treatment in the mandibular arch was also completed.
Fig 9: Post-treatment provisional prosthesis
Fig 10: Healthy soft tissue revealed at X weeks post-operative
Fig 11: Intraoral scan of healed upper arche in preparation for final prosthesis
Fig 12: Final prothesis delivered
Final restoration
A further digital scan was taken with the Medit i700 to fabricate the final prosthesis. Particular care was taken to scan the fitting surface of the provisional restoration so that the established contours and emergence profile could be replicated.
Both the provisional and final restorations were screw-retained and demonstrated a passive fit on first insertion. Ceramic surfaces in contact with the peri-implant soft tissues were left unglazed and highly polished to support soft tissue health.
Outcome
At delivery, the patient was delighted with the final result. Clinical review demonstrated excellent soft tissue integration and stable peri-implant tissues.
This case demonstrates how a digitally guided and prosthetically driven workflow can be used to manage a terminal maxillary dentition efficiently. Guided implant placement combined with immediate loading allowed a predictable full-arch FP1 rehabilitation while minimising the number of treatment stages for a highly anxious patient.
To discuss how you can implement the CONELOG® Progressive-Line into your implant practice, contact our team.
For all your implant educational needs, visit our dedicated education website, where you can find a range of courses to suit you.
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Article Author
Dr Alex Payne practises at Greasby Dental Centre in the Wirral. He has completed an Implant Diploma with the Royal College of Surgeons and is the Clinical Lead of the Smilefast Implant Diploma.
