Immediate Loading Implant-Supported Fixed Full-Arch Rehabilitation Using a New Clinical Decision-Support System: A Case Series

Abstract

Background Implant-supported full-arch rehabilitation is an effective treatment for edentulous patients. It restores mastication, facial aesthetics, and psychological well-being. Patient-related outcome measures support the validity of this approach, emphasizing the importance of effective prosthodontic interventions for this patient population. This study aims to present a case series for fixed implant-supported full-arch rehabilitation using the new Carames classification (CC). Methods A total of seven patients with generalized periodontitis or non-restorable multiple teeth were indicated for extraction and replacement with a fixed full-arch implant-supported prosthesis. According to the Carames classification, most cases were categorized as CCI or CCII classes for both the upper and lower jaws. Before the surgery, screw-retained provisional complete dentures were constructed and adjusted for the vertical occlusal dimension and smile lines. After the extractions, 70 implants were immediately placed in one or both arches for the seven patients, followed by bone grafts with the dual-zone grafting technique. Multi-unit abutments were then placed and welded to a metal bar for stable fixation. The provisional denture was fitted snugly over the metal bar for immediate functional loading. After three months of healing, it was used as a biocopy to fabricate the final prosthesis. The implant loss and the peri-implant marginal tissue health status were assessed annually for three years. Statistical analysis compared the marginal bone loss as a change from the baseline over the year. Results No implant or prosthesis loss was reported over the three years. Peri-implant marginal tissue health showed promising results without bleeding and suppuration on probing and probing depths between 3 and 3.5 millimeters. Marginal bone loss was minimal over the three years, with some cases showing bone gain. Conclusion Using the Carames classification as a clinical decision support system in implant-supported full-arch rehabilitation showed promising results in peri-implant tissue health and no implant loss during three years of follow-up. The implant placement and prosthesis fabrication protocol in this study could be valuable for further research.

Keywords: carames classification; full-arch rehabilitation; immediate functional loading; immediate implant; peri-implant marginal tissue health.

Figure 1. Preoperative CBCT scan (A) and intraoral photographs of the upper and lower jaws (B-D) show a failed long-span bridge with generalized periodontitis and non-restorable teeth.

Figure 2. Surgical steps in the upper jaw. (A) after extraction, (B) after implant placement, and (C) suturing.

Figure 3. Surgical steps in the lower jaw. (A) after extraction, (B) after implant placement and bone graft, and (C) suturing.

Figure 4. CBCT scan showing welded multi-unit abutment over implants (A) and intraoral photograph of the provisional denture in place as immediate functional loading (B).

Figure 5. Intraoral photograph for healing after three months for upper and lower jaws respectively (A, B), final prosthesis in place (C), and postoperative panoramic X-ray (D).

Figure 6. Boxplot showing marginal bone loss at different time points.

Figure 7. Boxplot showing marginal bone loss values concerning smoking patients (A) and none (B).