Patient Presentation
This patient presented after years of ongoing dental challenges, including advanced periodontal disease, recurrent decay, intermittent abscesses, and progressive discomfort. In addition to functional concerns, she expressed a strong desire for a more natural, esthetic smile and long-term improvement in her oral health.
Given the extent of dental breakdown, full-arch implant rehabilitation was indicated. While many clinicians default to the traditional All-on-4 approach—utilizing four implants per arch and restoring with a bulkier FP3 prosthesis that replaces both teeth and lost soft tissue—this patient’s underlying bone volume and soft tissue architecture allowed for a more refined and anatomically preserving solution.
We elected to proceed with an All-on-X (AOX) treatment concept utilizing six implants per arch, enabling the delivery of a highly esthetic and functionally superior FP1 prosthesis.
An FP1 prosthesis is designed to replicate only the natural teeth, emerging directly from the patient’s existing gingival architecture without replacing missing soft tissue. By preserving and working within the patient’s native tissue contours, this approach provides a restoration that is:
Achieving an FP1 outcome in a full-arch case requires a significantly higher level of precision compared to traditional AO4 approaches. Implant positioning must be prosthetically driven and exact, as there is minimal ability to compensate for discrepancies with prosthetic contouring. This demands meticulous planning, surgical accuracy, and extensive experience.
At Portland Perio Implant Center, we utilize a comprehensive digital workflow to execute these complex rehabilitations with precision. The process begins with detailed digital smile design and prosthetic planning, followed by CBCT-guided implant positioning. From this, we fabricate highly accurate surgical guides and prosthetic guides, ensuring that implant placement is fully aligned with the intended final restoration.
The Final Outcome
All temporization, as well as surgical and prosthetic guide fabrication, is performed in-house using advanced CAD/CAM technology and 3D printing. This allows for complete control over design, accuracy, and efficiency throughout treatment.
Final Prosthesis
