The ageing population has led to a subsequent rise in the demand for implants, as patients with fully edentulous jaws seek full arch implant treatment to improve their quality of life.[i]
Coinciding with this is the need for practitioners to have acquired the professional training and experience to safely and effectively undertake full arch rehabilitation so that they can better care for the growing number of edentulous patients looking for help.[ii]
Challenges in full arch implant rehabilitation
The necessity for advanced training and mentorship in full arch implant rehabilitation is elucidated when considering the complications within the surgical process that must be prevented or reduced. For instance, the optimal position for implant placement is harder to determine in extremely atrophied edentulous cases.[iii] Failing to stabilise the implant can compromise the surgery and harm the patient.
Anatomically and prosthodontically guided full arch implant placement can determine procedural success and ensure safety. Recent studies have shown that an overwhelming number of full arch implant treatments achieved successful stability with a guided implant approach, which requires the use of imaging technology like CBCT.[iv] Learning this skill at an advanced level reduces the risk of incorrect placement.
Low quality bone tissue can be another factor for premature full arch implant failure, with studies finding that health complications like diabetes and smoking correlate with weak bone tissue.[v] This hinders osseointegration and encourages the absence of primary stability during implant insertion, which is especially important for full arch treatment.[vi]
Managing osseointegration
Even if the implants are correctly placed then there is still a chance of failure during osseointegration, which will lead to high costs and a large time delay for the patient.
Osseointegration cannot always be guaranteed but it can be assisted. Bone density may need to beincreased with a bone graft, allowing the alveolar bone to regenerate naturally when given the space to do so. This can provide enough healthy bone for the implants to be placed. This procedure can delay a full arch implant as the bone may need several months to heal, although it can also be delivered simultaneously with implant placement in some situations. It may be worth considering the full arch solutions that do not require bone grafts in appropriate situations.[vii]
Yet, recent scientific developments in bone grafting have increased its appeal, with resorption controlled by binding RANKL to the protein osteoprotegerin, produced by osteoblastic cells. This remarkable breakthrough ensures osteological procedures, such as full arch implant rehabilitations, will meet with success by coaxing osseointegration with a more resilient alveolar bone.[viii]
Monitoring osseointegration can ensure success with the full arch implant restoration. There are several ways to do this, beginning with a clinical mobility test. A mobile implant is unequivocally non-integrated; however a stable implant is not conclusive evidence of osseointegration. Instead, radiographs can demonstrate a direct contact between the implant and the bone as fibrous tissue, which can tether itself to the implant, can be observed in radiolucent zones. Similarly, this does not guarantee osseointegration has occurred as images without the radiolucent zones may still contain undetectably small fibrous tissue.[ix] Aural techniques can determine whether the implant has succeeded as the generation of a percussive ringing noise through tapping the full arch implant will reveal if it has taken root or not.[x]
Learning Full Arch Implant Rehabilitation with industry experts
The Advanced Certificate in Full Mouth Oral Implant Rehabilitation promotes the ability for experienced implant dentists to effectively treat fully edentulous patients. Offered by the ICE Postgraduate Dental Institute and Hospital, the course has been developed by Professor Cemal Ucer, Specialist Oral Surgeon, and Professor Simon Wright MBE, two distinguished leaders in their field. Utilising face to face teaching, webinars and workshops, the programme allows implantologists to offer customised treatment options that enhance aesthetic, functional and anatomical outcomes for patients.
As revolutionary implant methods and technologies continue to permeate the dental sector, and as an ageing population continues to seek solutions to edentulism, the demand for full arch rehabilitation has never been higher. Progressive expertise on implant technique and osseointegration will allow clinicians to give patients a revelatory treatment with the best possible service and support.
Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co.
01612 371842
Author: Professor Cemal Ucer (BDS, MSc, PhD, Oral Surgeon, ITI Fellow)
[i] Izabela Turek , 25/05/2021, Dentistry, ‘it’s complicated – the challenges of using full arch dental implant rehabilitation
[ii] Yoon, D., Pannu, D., Hunt, M. and Londono, J. (2022). Occlusal considerations for full-arch implant-supported prostheses: a guideline. Dentistry Review, 2(2), p.100042. doi:https://doi.org/10.1016/j.dentre.2022.100042.
[iii] M. King, E. and Schofield, J. (2023). Restoratively driven planning for implants in the posterior maxilla – Part 1: alveolar bone healing, bone assessment and clinical classifications. British Dental Journal, [online] 235(8), pp.585–592. doi:https://doi.org/10.1038/s41415-023-6391-7.
Gökhan Göçmen, Ahmet Bayrakçıoğlu and Bayram, F. (2023). Effect of the level of alveolar atrophy on implant placement accuracy in guided surgery for full-arch restorations supported by four implants: an in vitro study. Head & face medicine, 19(1). doi:https://doi.org/10.1186/s13005-023-00387-w.
[iv] Dioguardi, M., Spirito, F., Quarta, C., Sovereto, D., Basile, E., Ballini, A., Caloro, G.A., Troiano, G., Lo Muzio, L. and Mastrangelo, F. (2023). Guided Dental Implant Surgery: Systematic Review. Journal of Clinical Medicine, [online] 12(4), p.1490. doi:https://doi.org/10.3390/jcm12041490.
Lerner, H., Hauschild, U., Sader, R. and Shahram Ghanaati (2020). Complete-arch fixed reconstruction by means of guided surgery and immediate loading: a retrospective clinical study on 12 patients with 1 year of follow-up. BMC Oral Health, 20(1). doi:https://doi.org/10.1186/s12903-019-0941-z.
[v] Perez Faverani, L., Adelino Ricardo Barao, Valentim., Ramalho-Ferreira, G., Aparecida Delben, J., Barbosa Ferreira, M., Rangel Garcia Junior, I., Goncalves Assuncao, W. (2014). The influence of bone quality on the biomechanical behavior of full-arch implant-supported fixed prosthesis. Materials, Science and Engineering: C, 37,p.164-170. doi:https://doi.org/10.1016/j.msec.2014.01.013.
[vi] Dioguardi, M., Spirito, F., Quarta, C., Sovereto, D., Basile, E., Ballini, A., Caloro, G.A., Troiano, G., Lo Muzio, L. and Mastrangelo, F. (2023). Guided Dental Implant Surgery: Systematic Review. Journal of Clinical Medicine, [online] 12(4), p.1490. doi:https://doi.org/10.3390/jcm12041490.
[vii] Soto-Penaloza, D., Zaragozi-Alonso, R., Penarrocha-Diago, M. and Penarrocha-Diago, M. (2017). The all-on-four treatment concept: Systematic review. Journal of Clinical and Experimental Dentistry. doi:https://doi.org/10.4317/jced.53613.
[viii] Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. 2, The Basics of Bone in Health and Disease. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45504/
[ix] Parithimarkalaignan, S. and Padmanabhan, T.V. (2013). Osseointegration: An Update. The Journal of Indian Prosthodontic Society, [online] 13(1), pp.2–6. doi:https://doi.org/10.1007/s13191-013-0252-z.
[x] Parithimarkalaignan, S. and Padmanabhan, T.V. (2013). Osseointegration: An Update. The Journal of Indian Prosthodontic Society, [online] 13(1), pp.2–6. doi:https://doi.org/10.1007/s13191-013-0252-z.
