Full Arch Dental Implant Algorithm (FADIA)

Full Arch Dental Implant Algorithm (FADIA)

Introduction

Welcome to the Full Arch Dental Implant Algorithm (FADIA), a comprehensive guide developed to streamline full-arch dental implant therapy. This publication presents an evidence-based approach, integrating the latest advancements in Partial Extraction Therapy (PET), facial aesthetic planning, and digital workflows. Our goal is to equip clinicians with a structured algorithm for optimal treatment planning and execution, enhancing functional and aesthetic outcomes for full-arch rehabilitation.

1. Understanding the Full-Arch Restoration Categories

Based on the Misch classification, three types of full-arch fixed prostheses are identified:

    •    FP-1: Replaces only the crown portion.

    •    FP-2: Restores the crown and part of the root.

    •    FP-3: Includes the gingival component, suited for cases with significant hard/soft tissue loss.

Clinical Insight: Most patients fall under the FP-3 category due to extensive bone loss or edentulism. However, bone preservation techniques like PET can allow FP-1 restorations in select cases, minimizing tissue loss.

Figure 1. Full-arch treatment options: FP-1 (A), FP-2 (B) and FP-3 (C).

2. Facial Aesthetic Planning

A successful outcome starts with meticulous aesthetic planning:

    •    Diagnostic Records: Digital photographs (resting and full smile) and facial scans.

    •    Intraoral Scans (IOS): For both arches, capturing tissue landmarks.

    •    Cone Beam Computed Tomography (CBCT): Critical for bone assessment and guide fabrication.

Figure 2. Photographs needed to ensure that the maximum smile line is captured.

Digital Tools: Smile Designer Pro, Exocad, and 3Shape aid in aligning 2D and 3D data to create a virtual patient, ensuring precise treatment planning.

3. Decision Tree Algorithm for Full-Arch Implants

The FADIA model categorizes tooth loss into two main etiologies:

    •    Periodontal Disease/Edentulism

    •    Decay/Wear

Key Considerations:

    •    Gingival Display: High smile lines often require bone reduction for aesthetic harmony.

    •    Prosthetic Space Requirements: Hybrid prostheses need 12–15 mm, while monolithic zirconia requires 11–14 mm.

Algorithm Steps:

    1.    Assess gingival display and bone structure.

    2.    Determine prosthetic design (FP-1, FP-2, FP-3).

    3.    Decide on PET based on root structure viability and clinical conditions.

Figure 3. Full Arch Dental Implant Algorithm (FADIA)

4. Extramaxillary Approaches: The PATZI Protocol

For severe bone loss, the PATZI protocol combines:

    •    Pterygoid Implants

    •    Anterior Tilted Implants

    •    Zygomatic Implants

Clinical Tip: If standard implants fail, consider extramaxillary options for sufficient support.

5. Partial Extraction Therapy (PET) in Full-Arch Cases

PET techniques, such as the Socket Shield (SST) and Root Submergence (RST), preserve hard and soft tissue integrity.

Decision Point: PET is ideal when:

    •    Sufficient root structure remains post-alveoplasty.

    •    There’s no large periodontal infection or labial plate loss.

6. Full-Arch Workflow: Digital and Analog Approaches

Digital Workflow:

    •    Preoperative: IOS, CBCT, facial scans.

    •    Surgery Day: Digital prosthetics transferred to surgical data using reference markers.

    •    Postoperative: Provisional fitting and final prosthesis adjustments.

Analog Approach: Used when digital tools are limited, relying on conventional guides and impression techniques.

Conclusion

The FADIA framework emphasizes a systematic, patient-centered approach to full-arch dental implants. By integrating PET, digital planning, and extramaxillary options, clinicians can achieve superior aesthetic and functional outcomes.

Future advancements in guided technology and PET protocols will continue to refine this algorithm, ensuring even greater success in full-arch rehabilitations.