Plate 03 · Procedures
Full-arch restoration
The graftless tilted-implant concept exists because it lets a patient leave with fixed teeth on the day, in bone that would otherwise have needed a year of augmentation. That is a genuine advance. It is also the procedure most often oversold, so this page spends more words on the limits than on the appeal.
For the referring practice
Fixed full-arch rehabilitation on four to six implants, with tilted posterior fixtures where anatomy allows, and immediate provisionalisation where cross-arch stability permits.
In plain language
A fixed set of teeth for a whole jaw, held on four to six implants. It is a big decision, it is not reversible, and it needs cleaning every day for the rest of your life.
Both are always on this page. The switch in the header decides the order everything else is presented in, not whether you are allowed to read it.
01
When we would operate
And, just as importantly, when we would not. A referral that ends in a recommendation to do nothing is a good outcome, not a wasted appointment.
- Terminal dentition with a strategic decision to clear the arch rather than chase individual teeth
- An existing complete denture the patient cannot tolerate, particularly a lower
- Atrophic posterior maxilla or mandible where axial posterior placement would need major grafting
- A patient who understands and accepts a lifetime of hygiene and prosthetic maintenance
02
How it is done
Planning and the prosthetic endpoint
The plan starts from the finished tooth position and lip support, works backwards to the prosthetic platform, and only then decides implant positions. Virtual planning from CBCT plus a scan of the existing denture or a wax-up.
Alveoloplasty
The transition line has to be hidden. That means deliberately reducing bone to create restorative space for the prosthesis and to place the junction above the smile line. This is why the procedure is not reversible.
Tilted posterior implants
Distal fixtures angled to emerge anterior to the mental foramen or the maxillary sinus, engaging more bone and shortening the cantilever. Multi-unit abutments correct the angulation prosthetically.
Immediate provisional
A fixed provisional is delivered the same day only when each fixture has adequate insertion torque and the arch can be splinted cross-arch. If the torque is not there, we say so and fit a healing denture instead. Delivering a provisional onto an unstable fixture is how arches fail.
Final prosthesis
After four to six months, once integration and soft-tissue maturation are complete. Usually a milled titanium bar with a ceramic or high-performance polymer superstructure.
- CBCT of the arch, with the existing denture worn and a radiopaque marker if one exists.
- Intraoral scan or impressions of both arches.
- Full-face photographs at rest and at full smile — the transition line is decided here.
- A frank note on periodontal status and remaining tooth prognosis.
A note back to you
We are glad to see these cases jointly. Tell us whether you want to restore the arch or hand it over, and at what stage. If you are restoring, we will plan the fixture positions with your lab and deliver the arch to a multi-unit platform you specify.
04 · Consent
Risks, stated rather than softened.
Every figure below is a published-literature range and is labelled as one. None of them is a claim about this practice's results, and there are no success rates anywhere on this site. You should hear all of this out loud before you consent to anything, not only read it.
Implant failure in an arch
Losing one fixture in a four-implant arch is not equivalent to losing one of many. It can mean removing the prosthesis, grafting, and rebuilding. We will discuss where additional fixtures buy resilience.
Prosthetic complications
The commonest problem by a wide margin. Fracture of the provisional, chipping of the definitive material, screw loosening, wear of the opposing dentition. Expect maintenance appointments; budget for them.
Literature: prosthetic complication rates over 5–10 years are frequently reported above 30%
Speech and adaptation
Most people adapt within weeks. Some never fully lose a lisp, particularly in the maxilla where the prosthesis changes the palatal contour.
Hygiene access
The undersurface must be cleanable and must be cleaned daily with superfloss or a water flosser. Peri-implant mucositis under a fixed arch is easy to miss and hard to reverse.
Irreversibility
Teeth are removed and bone is reduced. There is no returning to the previous dentition, and going back to a conventional denture after alveoloplasty is a poorer denture than the one you had.
MRONJ and medical risk
Extensive extractions and alveoloplasty in a patient on antiresorptives is a high-risk combination. Full medical and drug history before we plan, not on the morning.
05
What the timeline looks like
Recovery varies between people. The general recovery instructions — bleeding, swelling, diet, medication timing and dry socket — are on the after-your-surgery page.
06 · For patients
The questions people actually ask us in the chair.
Is this "teeth in a day"?
A fixed temporary set in a day, yes, when the implants are solid enough on the day. The final teeth come four to six months later. Anyone who tells you the finished result is delivered in one day is describing the temporary.
What will it feel like?
A long appointment, usually under sedation, then several days of swelling and bruising. You will be on a soft diet for weeks, not days. The first fortnight is genuinely tiring.
The part people are not told
This has to be cleaned underneath, every day, for life. If that is not realistic for you, say so now and we will talk about an implant-retained overdenture you can take out to clean instead. That is not a lesser option — for some people it is the better one.
07
More on this procedure
Next
Send us this case with the imaging listed above, or call the referral line on (612) 555-0150 if it needs to be seen sooner than a form allows.
If your dentist has already referred you, we will contact you to book. If you would like a second opinion, you can come to us directly.