So, you’ve placed your first single implant. What’s next? The answer, probably, is providing more single implants, working up to restoring an edentulous dentition with a bridge or multiple crowns. However, the dream for many implant dentists will be the ability to routinely and confidently restore an entire arch.
The step-up in complexity between lone implant and full arch solution is large to say the least. Developing confidence in surgical and restorative abilities to ensure an aesthetic and functional result that will stand the test of time doesn’t happen overnight. Clinicians should embrace this learning journey, and ask themselves how to make the most of it.
Read up
The first step is to delve into the available literature, and begin understanding key aspects of full arch solutions from a theoretical point of view.
It’s important to understand the biomechanics and implant distribution required in order to balance occlusal forces and deliver effective function,[i] whilst minimising risk of failure. The literature notes that in the maxilla, the antero-posterior distribution of dental implants affects the survival rates of a full arch prosthesis.i When the distribution of implants leans more towards the anterior, patients are at risk of severely worsened survival rates compared to those with an adequate anterior-posterior balance – interestingly, this doesn’t apply so strongly in the mandible.i
Clinicians will also need to advise patients with treatment plans that use a removable or fixed full-arch prosthesis. Factors that could influence the choice between the two include cost, where fixed prostheses demand greater investment; patient expectations; overall patient health; anatomical considerations; and access for optimal hygiene and maintenance.[ii] A 2021 systematic review found that after 5 years of use, fixed designs tended to have improved outcomes, but effective management of peri-implantitis is key to positive outcomes in both approaches.[iii]
Immediate and bone grafts
Some aspects of treatment in complex single- and multi-unit dental implants can be replicated in full-arch treatment, and may be needed for any chance at a successful result. This includes immediate implant placement, and the utilisation of soft- and hard-tissue augmentation.
Full-arch implants have presented high survival rates with all loading protocols, and early and immediate loading can be looked upon as favourably as conventional approaches. Patient selection is key, as bone quality and quantity, and implant design, can each affect the outcome of treatment.[iv] This can only be learnt by reviewing successful and unsuccessful cases in the literature, and hearing from clinicians who have completed immediate implants in the full arch to note what they consider to look out for. Putting the technique into practice is another challenge altogether; clinicians must be confident with the immediate implant protocol, and should be comfortable carrying out the treatment at multiple sites before considering its use here.
One common complication of immediate implant placement includes mid-buccal gingival recession, which may prompt a tissue graft.[v] Bone grafts have also been recommended to preserve ridge width and volume, improving aesthetic outcomes.v Many patients will also require a bone graft (or multiple) to ensure functional longevity. Consider that many patients will have lost their teeth through difficulties such as periodontal disease, which affects and destroys the tooth-supporting alveolar bone.[vi]
To ensure that full-arch implant treatments are predictable, it’s important for dentists to have confidence in identifying the need for and carrying out successful tissue augmentation. Much like the placement of immediate implants, this cannot be learned through theory alone – seeking hands-on experiences is key.
Gain experience
The General Dental Council’s ‘Standards for the Dental Team’ notes that clinicians must only deliver treatment and care if they have the necessary training, and are competent.[vii] With full arch implant dentistry, clinicians need to be highly-skilled in a number of areas – from case assessment, to the ability to plan for a large prosthesis, the surgical skills to place implants accurately, without even mentioning the additional considerations for immediate implant procedures and tissue augmentation.
The PG Diploma in Advanced Techniques in Implant Dentistry from One to One Implant Education combines all of the skills needed to tackle complex cases, including full arch rehabilitation, in one unique course. It is suited to ensure professionals provide long-lasting care, delving into tissue augmentation and complication management to set your skills apart from competitors. Led by Dr Fazeela Khan-Osborne, course founder and leading implant clinician based in London, dental professionals match theoretical content with hands-on sessions for an in-depth study into advanced implant care.
There are many elements of the full-arch implant workflow that clinicians must master before taking on regular cases. Finding educational opportunities to dive into the literature and practice complex techniques hands on is a surefire way to gain competence and confidence with time.
To reserve your place or to find out more, please visit https://121implanteducation.co.uk or call 020 7486 0000
Authors: Dr Fazeela Khan-Osborne and Dr Nik Vourakis
Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice. Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20th year. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.
[i] Daudt Polido, W., Aghaloo, T., Emmett, T. W., Taylor, T. D., & Morton, D. (2018). Number of implants placed for complete‐arch fixed prostheses: A systematic review and meta‐analysis. Clinical oral implants research, 29, 154-183.
[ii] Vazouras, K., & Taylor, T. (2021). Full-arch removable vs fixed implant restorations: A literature review of factors to consider regarding treatment choice and decision-making in elderly patients. Int J Prosthodont, 34, s93-s101.
[iii] Ramanauskaite, A., Becker, K., Wolfart, S., Lukman, F., & Schwarz, F. (2022). Efficacy of rehabilitation with different approaches of implant‐supported full‐arch prosthetic designs: A systematic review. Journal of clinical periodontology, 49, 272-290.
[iv] Velasco-Ortega, E., Cracel-Lopes, J. L., Matos-Garrido, N., Jiménez-Guerra, A., Ortiz-Garcia, I., Moreno-Muñoz, J., … & Monsalve-Guil, L. (2022). Immediate functional loading with full-arch fixed implant-retained rehabilitation in periodontal patients: Clinical study. International journal of environmental research and public health, 19(20), 13162.
[v] El Ebiary, S. O., Atef, M., Abdelaziz, M. S., & Khashaba, M. (2023). Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial. BMC Research Notes, 16(1), 331.
[vi] Di Benedetto, A., Gigante, I., Colucci, S., & Grano, M. (2013). Periodontal disease: linking the primary inflammation to bone loss. Journal of Immunology Research, 2013(1), 503754.
[vii] General Dental Council, (2019). Standards for the dental team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed June 2025]
