Transition from hopeless dentition to full-arch fixed-implant-supported rehabilitation by a staged extraction approach: Rationale and technique

Transition from a hopeless dentition to a fixed-implant-supported full-arch reconstruction can be difficult for patients if wearing a transitional removable denture is involved. In addition, an increased risk for trauma to bone augmentation areas and to the implant-bone interface exists when using a removable transitional complete denture during the implant healing period; such risk can compromise implant success or increase crestal bone loss around implants before the final restoration. This article describes a treatment approach that allows replacement of the hopeless dentition with an osseointegrated fixed prosthesis, without rendering the patient totally edentulous before the delivery of the final implant-supported prosthesis. A staged approach using a few hopeless teeth to support a provisional fixed restoration during the healing process can help avoid discomfort and improve implants' outcome. A treatment plan for a maxillary arch reconstruction is used to illustrate the staged approach protocol. This protocol addresses patients' psychologic need to remain dentate during partial or full-mouth rehabilitation, while providing good esthetics and function during restoration of a dental arch.