Guidelines for Full Arch Rehabilitation
The 10 Commandments of Immediate Full Arch Rehabilitation
Proper general and local examination should be done prior to surgery. Normal general and local contraindications for surgery should be respected. The below recommendations are guidance for Southern Implant protocol.
1) Evaluate hard and soft tissue
Keratinized mucosa surrounding the abutment / prosthetic construction is a prerequisite for good long-term success. Consider grafting if lack of keratinized mucosa.
Hard tissue evaluation gives:
a. Selection of implant, Co-Axis (12, 24 or 36) MAX, Short or Zygomatic or regular implants.
b. In the Maxilla analyze outer border of sinus maxillaries. It will give proper angulation of Co-Axis for most posterior placement. If sufficient bone below sinus consider Max Implant if bone width allows for it.
c. In the maxillary front Co-Axis implants, often 12-degree angulation, is to be considered for palatal screw entrance and more mid-facial soft tissue.
d. In the mandible, depending on vertical placement of the mandibular nerve, different angulation of Co-Axis can be used.
2) Consider guide for proper placement
A guide will help you find the optimal position and optimal angulation of the osteotomy. Use direction indicator dedicated for Co-Axis for guidance.
3) Evaluative bone quality and adapt surgical protocol for good primary stability
Depending on bone quality different final drills should be used. In soft bone reduce final drill diameter and in dense bone consider tap. A final seating torque above 30-35 Ncm is consider as safe for immediate loading.
4) Verify position/angulation before placement
Use dedicated direction indicators for evaluation of angulation and proper depth.
5) Place to sufficient depth and keep sufficient buccal bone
Platform of the implant must be placed at least 1-2mm beneath the lowest point of the buccal wall. 2 mm of buccal bone should be kept and at least 3 mm of inter implant space kept.
Start placing the most posterior implants. Angulated implants might block anterior implant site and adaptation in length might be needed.
6) Consider compact conical abutments
With proper implant placement, straight compact conical abutments can be used. By using abutments no interference of connective tissue and contact epithelium is violated giving a minimum bone remodulation. Moreover, less stress is transferred to the implant.
7) Stress-free temporary prosthetic construction
The temporary construction should have a perfect fit to the implant/abutment. It should have a stabile occlusion and articulation. Consider low cusp design. Do not violate the A-P spread guideline. During temporary phase consider minimal counter-liver to reduce stress on the posterior implants and eliminate risk of fracture.
8) Initial Follow-up
Post-operative instructions include: soft diet and hygiene maintenance.
9) Use original prosthetic components
Original prosthetic components guarantee optimal fit. Consider passive abutment for stress-free fit.
10) Follow-up and maintenance
Post-operative instructions include: hygiene instruction and help to maintain a good oral hygiene. Periodic radiographs, occlusion check-ups.