Decision Tree Algorithm for Full Arch Dental Implant Therapy: Part 3

Decision Tree Algorithm for Case Planning

The etiology of tooth loss is important to understand and is broken down into two categories in the decision tree algorithm for full arch implant therapy: periodontal disease/edentulous and decay/wear . Critical analysis of the starting condition of each potential full arch candidate involves radiographs, CBCT, Intraoral scan or PVS impressions in addition to high quality photographs at rest and in full smile as discussed. The photos taken are especially critical to avoid transition line issues due to high lip line patients.

To PET or not to PET 

In our decision tree algorithm for choosing to perform PET or not, we need to understand the etiology of the tooth failure. In the last section we noted that tooth loss etiology can be broken down into periodontal disease/edentulous patients and decay/wear patients. The decision to perform PET for the decay/wear patient will depend on the lip line/gingival display and the remaining root structure left if alveoplasty is necessary.  Alveoplasty for the decay/wear patient is indicated in two circumstances: 1)high smile line requiring bone reduction or 2) prosthetic space requirement is insufficient and increasing the vertical dimension opening of the patient is not indicated

If alveoplasty is indicated and 7-8mm or approximately 2/3 of the root structure remains after the bone reduction is performed, then it may be possible to use an FP1 approach with PET. Other contraindications to PET would also include mobile teeth, lack of labial plate, large periodontal infections or if the teeth are not in a suitable position in the arch such that preservation would not coincide with the final prosthetic driven treatment plan.