Key Considerations for Full-Arch Rehabilitation

Full-arch rehabilitation can be life-changing for patients with terminal dentition or edentulism, restoring function, esthetics, and confidence. However, this complex treatment demands more than clinical skill, it requires a comprehensive evaluation of each patient’s health status, habits, and expectations. By identifying potential risk factors early, clinicians can improve outcomes, reduce complications, and guide patients toward the most appropriate and sustainable treatment plan.

Medical History Factors

• Systemic conditions affecting implant healing and success

1. Uncontrolled diabetes (HbA1c > 8%) impairs healing and increases implant failure risk, while research indicates that well-controlled diabetes does not significantly affect implant outcomes.^1,2
2. Osteoporosis and medications to treat it, such as bisphosphonates and denosumab, increase osteonecrosis risk, requiring careful risk-benefit analysis before implant placement.³
3. Autoimmune diseases (eg, rheumatoid arthritis, lupus, Sjogren syndrome) may compromise healing abilities. Xerostomia may affect both implants and natural teeth.^4-6
4. Cancer history, particularly head and neck radiation therapy, increases osteoradionecrosis risk and requires special consideration.

Medications

1. Immunosuppressants and corticosteroids may delay healing and increase infection risk, while anticoagulants can elevate bleeding risk during extractions and implant surgery.^7,8

Lifestyle

1. Heavy smokers (> 10 cigarettes daily) face increased risks of implant failure and periodontal disease.⁹ For patients unable to reduce or quit smoking, treatment may favor preserving natural teeth or considering nonimplant prosthetic options.¹⁰
2. Alcohol or drug use may indicate potential compliance and hygiene challenges.^11-13

Financial and Psychological Factors

• Cost is a significant factor, as full-arch rehabilitation for either natural teeth or implants represents a substantial financial investment that may be prohibitive for some patients.
• Additionally, patient expectations and compliance largely determine treatment prognosis. For patients unwilling or unable to maintain proper oral hygiene, full-arch rehabilitation may not be the optimal solution.

A thoughtful, individualized assessment is the cornerstone of successful full-arch rehabilitation. By considering systemic health, medications, lifestyle behaviors, and psychosocial readiness, dental teams can select candidates most likely to benefit from treatment and provide them with the support they need for long-term success.

References

1. Marchand F, Raskin A, Dionnes-Hornes A, et al. Dental implants and diabetes: conditions for success. Diabetes Metab. 2012;38:14-19.
2. Chrcanovic BR, Albrektsson T, Wennerberg A. Diabetes and oral implant failure: a systematic review. J Dent Res. 2014;93:859-867.
3. Otto S, Pautke C, Van den Wyngaert T, Niepel D, Schiødt M. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treat Rev. 2018;69:177-187.
4. Duttenhoefer F, Fuessinger MA, Beckmann Y, Schmelzeisen R, Groetz KA, Boeker M. Dental implants in immunocompromised patients: a systematic review and meta-analysis. Int J Implant Dent. 2019;5:43.
5. Zheng F, Annamma LM, Harikrishnan SS, Lee DJ. Systemic factors affecting prognosis in restorative and prosthetic dentistry: a review. Dent Clin North Am. 2024;68:751-765.
6. Ergun S, Katz J, Cifter ED, Koray M, Esen BA, Tanyeri H. Implant-supported oral rehabilitation of a patient with systemic lupus erythematosus: case report and review of the literature. Quintessence Int. 2010;41:863-867.
7. Plemons JM, Al-Hashimi I, Marek CL. Managing xerostomia and salivary gland hypofunction: executive summary of a report from the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2014;145:867-73.
8. Brennan MT, Wynn RL, Miller CS. Aspirin and bleeding in dentistry: an update and recommendations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:316-323.
9. Bain CA, Moy PK. The association between the failure of dental implants and cigarette smoking. Int J Oral Maxillofac Implants. 1993;8:609-615.
10. Porter JA, von Fraunhofer JA. Success or failure of dental implants? A literature review with treatment considerations. Gen Dent. 2005;53:423-432.
11. Rossow I. Illicit drug use and oral health. Addiction. 2021;116:3235-3242.
12. Teoh L, Moses G, McCullough MJ. Oral manifestations of illicit drug use. Aust Dent J. 2019;64:213-222.
13. Baghaie H, Kisely S, Forbes M, Sawyer E, Siskind DJ. A systematic review and meta-analysis of the association between poor oral health and substance abuse. Addiction. 2017;112:765-779.

This originally appeared in Chang B. The evolution of full-arch implant rehabilitation. Decisions in Dentistry. 2025;11(3):10-15.