Julius Wolff has a bone to pick

In the realm of full-arch implant dentistry, our primary goal should be to provide long-lasting, functional, and esthetically pleasing outcomes for our patients while prioritizing their overall oral health. A cornerstone of achieving this lies in the principle of bone preservation. Recognizing the critical role of the alveolar ridge, not only in supporting dental implants but also in maintaining facial structure and gingival architecture, is paramount.

Traditional approaches to full-arch rehabilitation, such as some All-on-X protocols, necessitate the removal of healthy bone to accommodate a prosthetic designed with an artificial acrylic, zirconia, or ceramic gumline. While these methods offer a solution for edentulous patients, the removal of viable bone can have several physiological disadvantages. This can lead to compromised proprioceptive feedback, potentially affecting the patient’s ability to perceive the function and position of their restoration.

Furthermore, the reduced bone volume can limit future implant placement options should the need arise. The prosthetics can also create difficult-to-clean areas that are prone to plaque accumulation, potentially increasing the risk of peri-implant disease.

In contrast, the FP1 classification of implant-supported prostheses prioritizes the preservation of the patient’s existing alveolar bone and natural gingiva. Procedures like the 3 on 6™, which utilize multiple TRI implants to support individual bridges, exemplify this philosophy. By focusing on replacing only the missing teeth, FP1 restorations avoid the need for extensive bone removal. This approach allows for the emergence of prosthetic teeth directly from the patient’s natural gingival tissues, contributing to a more natural appearance and improved patient comfort.

A significant physiological benefit of FP1 restorations, particularly those utilizing segmented bridges, is the potential for continued bone stimulation. Julius Wolff, a German anatomist and surgeon, coined what would be known as Wolff’s Law, which stated that bone in a healthy animal will adapt to the loads under which it is placed. In other words: our bones degrade without significant loads placed on them. We need only to look at a limb that has been splinted in a cast to see this theory in action.

Unlike a monolithic full-arch prosthesis, segmented bridges allow for a degree of independent movement of each segment during mastication. This functional loading on the individual implant fixtures and the surrounding bone can stimulate bone modeling and help prevent resorption over time. The distribution of occlusal forces across multiple, independently supported units may contribute to greater physiologic stresses within the alveolar bone and bone modeling. This contrasts with single-unit, full-arch restorations where occlusal forces are distributed across all implants as a single unit, potentially leading to bone remodeling.

By embracing sound principles and techniques that prioritize bone preservation and physiological stimulation, we can strive for more predictable long-term success and enhanced quality of life for our patients undergoing full-arch rehabilitation.