Welcome to part 2 of our blog series on full arch implant treatment options. Last time we discussed the various prosthetic options ranging from FP1-FP3 with rational of choice behind the treatment.
Although most cases will fall under the FP3 category, there are instances where an FP1 case (crown and bridge style) may be possible to achieve. Some critical elements an FP1 style treatment involves:
Use of more implants
Implants placed in prosthetic tooth positions
Planning for prevention-how to deal with future recession ?
Use of more implants: a typical FP3 style case typically involves commonly what we hear all the time which is an "all on 4" style of treatment. Although 4 implants is the MINIMUM number of implants we need to restore someone in a fixed prosthesis, I am an advocate of using more implants in case of future complications or implant loss. Typically I will place 5 implants in the lower jaw between the foramena and 6 implants in the upper jaw between the sinuses. Typically for an FP1 style case, we will be using more implants so that we do not have large pontic areas of unsupported prosthetic material as the vertical dimension of prosthesis tends to be shorter in FP1.
Implants placed in prosthetic tooth positions: In a typical FP3 style case, we may need to angulate our posterior implants to avoid critical anatomy (IAN resorption in the posterior lower jaw, sinus pneumatization). This is an effective technique that often leads to extension of our prosthesis distally often allowing for a 1-2 tooth cantilever. While this is technique works quite well, we need adequate vertical height of prosthesis thickness to ensure that we do not run into fractures or prosthetic material breakdown. For an FP1 style case, often the implants will need to be placed in the appropriate prosthetic tooth position, meaning no cantilevers.
Planning for prevention-how to deal with future recession: Typically in FP3 style cases, bone reduction is performed to allow for implant placement. This technique allows for implant placement in basal bone. Basal bone is denser and less porous than alveolar bone. Alveolar bone is the part of the jaw that holds the teeth. When we replace a single tooth with a dental implant, the adjacent teeth and PDL blood supply prevent extensive resorption. Now imagine, if ALL the teeth are extracted and are replaced with dental implants, the PDL is GONE! Although your case can look great at year 1, 3, 5 etc, if the tissue is thin or implants are placed not deep enough or too buccal, then this is a recipe for disasters with FP1 treatment. So how to we resolve this ?
Part 3 of our blog will touch base on FP1 complications and Partial Extraction Therapy concepts
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