Full-arch rehabilitation on implants: indications and planning

Full-arch rehabilitation on implants requires careful planning, precise tissue management, and a clear prosthetic vision from the very beginning of the treatment journey.

Full-arch implant-supported rehabilitation is one of the most complex procedures in implant dentistry. It consists of the functional and aesthetic restoration of a complete or nearly complete dental arch through a fixed prosthesis supported by implants. When well planned and properly executed, it produces stable, functional and aesthetically satisfying long-term results. When approached without adequate planning, it generates complications that are often difficult, or impossible, to correct.

When is it indicated

Full-arch rehabilitation on implants is indicated in the presence of:

• Complete or near-complete edentulism, with loss of all or nearly all teeth in an arch.
• Advanced compromise of all remaining elements, where maintaining the residual teeth is not clinically justifiable.
• Retreatment of patients with removable dentures (complete removable prosthesis) that do not meet the patient’s functional expectations.
• Retreatment of existing full-arch rehabilitations with complications: loss of teeth or anchorage implants; prosthetic fractures; phonetic or masticatory problems.

Immediate loading and deferred loading protocols

Full-arch rehabilitations can be carried out with different timing protocols. The immediate loading protocol (placement of the provisional prosthesis at the same surgical session as implant placement) is possible where adequate primary stability and favourable bone conditions are present. The deferred protocol involves a healing phase before prosthetic loading.

The choice of protocol is not dictated by the clinician’s preference or the patient’s request: it is the result of an assessment of bone conditions, the number and position of implants, the patient’s systemic condition, and the quality of the soft tissues.

The importance of preliminary prosthetic planning

One of the most frequent errors in full-arch rehabilitation is approaching the surgical phase without a defined prosthetic plan. Implant position must be determined by the prosthesis it will support, not by the available bone volume in the absence of prosthetic planning. Well-osseointegrated implants in prosthetically unfavourable positions produce prostheses that do not function well and, above all, do not last.

Rational planning involves: complete aesthetic and functional analysis, diagnostic wax-up or digital mock-up, digital surgical guide (where indicated), and planning of the provisional prosthesis before surgery begins.

Soft tissue management

Full-arch rehabilitation is not only bone surgery and prosthetics. Management of the peri-implant soft tissues significantly determines the final aesthetic result, the ease of patient hygiene, and the longevity of the implants. A full-arch prosthesis that does not allow the patient to maintain correct peri-implant hygiene is bound to generate biological complications over time.

The emergence profile of the prosthesis, the relationship between the prosthesis and the tissues, the quantity of keratinised peri-implant mucosa: these are all elements to be considered at the planning stage, and they determine the quality of the long-term result.

Retreatment of full-arch rehabilitations

Existing full-arch rehabilitations that have generated complications represent the most complex clinical situations. Loss of implants, fractures of the prosthetic framework, peri-implant biological problems in the presence of full-arch prostheses all require a detailed causal analysis before any retreatment hypothesis.

Studio Calesini manages this type of case within its approach to implant-prosthetic retreatments: causal analysis always precedes planning, and prosthetic planning always precedes the surgical phase.