The patient presented to our clinic with an All-on-4 rehabilitation of the upper arch compromised by advanced peri-implantitis, characterized by significant peri-implant bone loss and a hopeless prognosis for the existing implants. The lower arch had two implants affected by chronic infection with bone loss, making their retention impossible.
Phase I – Diagnosis and Planning
Clinical examination, CBCT analysis, and digital treatment planning were performed. After evaluation, it was decided to remove all implants with a hopeless prognosis and proceed with full-mouth rehabilitation using a new implant plan.
Phase II – Surgical Treatment
- Removal of the existing All-on-4 prosthesis
- Explantation of the four upper arch implants affected by peri-implantitis
- Explantation of the two infected implants in the lower arch
- Complete debridement of inflammatory tissue and cleaning of surgical sites
- Alveolar preparation and implant surgery according to the prosthetic plan
Phase III – Implant Placement
After establishing a healthy bone base, new implants were placed in strategic positions for full rehabilitation of both arches. Primary implant stability was assessed as adequate for treatment continuation.
Phase IV – Prosthetic Rehabilitation
After the osseointegration period, definitive impressions were taken and the fixed restoration on implants was completed. Vertical dimension, occlusion, phonetics, and aesthetics were carefully verified, ensuring optimal distribution of functional loads.
Result
The final rehabilitation restored:
- Masticatory function
- Natural smile aesthetics
- Occlusal stability
- Peri-implant tissue health
- Comfort and quality of life
Conclusion
This case demonstrates that even in the presence of advanced implant failure due to peri-implantitis, careful planning and surgical-prosthetic treatment performed according to modern protocols can successfully restore oral function and aesthetics.
Treatment performed by Dr. Shukri Jahiu at Dental Health Clinic – Tirana, Albania.
