Case Study: Guided Maxillary Full-Arch Revision, Seven Failing Implants to Four

A maxillary full-arch reconstruction supported by seven implants had failed, with significant peri-implant bone loss around the fixtures. All seven fixtures were explanted and the arch was restored on four new implants in the same surgical visit, fully guided and immediately loaded. TrueGuide Dental planned the case from the CBCT and the intraoral scan and printed the TrueGuide Stackable guide system.

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Case at a Glance

• Arch: maxilla

• Presentation: failing full-arch reconstruction on seven implants with significant peri-implant bone loss

• Explanted: seven implants

• Placed: four implants, fully guided, in prosthetically driven positions

• Guide: TrueGuide Stackable system on a metal-reinforced base template locked with bone-anchored fixation pins

• Grafting: residual osseous defects grafted at the same appointment

• Abutments: multi-unit abutments, straight anteriorly and angled posteriorly

• Loading: immediate, with a prefabricated PMMA screw-retained interim prosthesis

• Surgical visits: one

Surgical Sequence

• Reference capture: the metal-reinforced base template was seated and locked with bone-anchored fixation pins while the seven failing implants were still in place, so the planned position was transferred from the existing reconstruction and held after the arch became edentulous. Every later template stacked on that base.

• Explantation and site management: the seven fixtures were removed, the sites were debrided of granulation tissue, and the residual osseous defects were grafted at the same appointment.

• Guided placement: four implants were placed through the stacked osteotomy template in prosthetically driven positions, with primary stability confirmed at placement before the arch was loaded.

• Abutment-level conversion: multi-unit abutments were seated at surgery, straight anteriorly and angled posteriorly, to establish a common path of insertion at abutment level.

• Immediate provisional: a prefabricated PMMA screw-retained interim prosthesis was carried to place in an index keyed to the same base template and picked up intraorally on temporary cylinders, with the surgical field isolated under rubber dam during the pick-up.

Outcome

Seven failing fixtures were reduced to four that carry the arch, and the patient left the visit with a fixed screw-retained provisional, with esthetics and vertical dimension restored in that single guided appointment. The definitive prosthesis is designed from the same digital plan that produced the guide.

What the Literature Reports

Implants placed at previously failed sites survive at 96.7 percent after one year across 24 studies and 1,947 implants, and immediate replacement performs no worse than delayed replacement. Four-implant and six-implant full arches survive at 98.1 and 97.5 percent beyond five years, so reducing seven fixtures to four changes the support strategy rather than the prognosis.

Planning and guides by TrueGuide Dental. Surgery performed by the treating clinician.

Plan a Similar Case

Upload the CBCT, intraoral scan and Rx on the Submit a Case page or call (201) 255-4233. Guide packages are on the TrueGuide Pro page, and the other four cases are on the Case Studies page. How a stackable guide keeps one reference through the extractions is covered in Stackable Guides for Full-Arch.