How I plan a Full Arch Case

When I teach and mentor full arch implant treatment, I always emphasise to colleagues the importance of planning.

As Stephen Covey said “All things are created twice; first mentally; then physically.  The key to creativity is to begin with the end in mind, with a vision a blueprint of the desired result.”

This is exactly how we should be approaching full arch implant treatment, with it being clear in our minds the type and material of prosthesis which will be fabricated as a definitive restoration for the patient.  It is only when we have the “end in mind” can we then work retrospectively to create.

Prior to planning a case a comprehensive history, psychological assessment and an understanding of patient expectations is important.

Clinical assessment will guide the decision making process in identifying if a full arch implant solution is an acceptable treatment plan and also if a fixed and/or removable solution is available.  

Often we are faced with a dilemma when patients have a number of healthy teeth remaining and a decision needs to be made to sacrifice these for a full arch treatment option.  It is always a difficult decision to remove healthy teeth however consideration needs to be made to the long term prognosis of remaining teeth,  associated morbidity working with existing teeth, financial implications and treatment duration.

A cone beam CT is essential in identifying bone availability and once we have all this information we can PLAN.

A great software I love using which works on mac and windows is blue sky bio.  It is free to download and very user friendly.  It allows me to request only dicom files from colleagues irrespective of what CBCT machine the scan was taken on and easily view and plan the case.    

Finally, it is important not to limit a treatment plan to fit your skill set but to pick the most appropriate treatment plan based on patients desires and clinical assessment.  Full arch implant treatment is a process and treatment planning forms the foundation, master this and you will save a lot of heartache for the patient and headache for yourself.