A complex case presenting with multiple failing teeth, compromised implants, and extensive fixed prosthetic restorations, requiring comprehensive reconstruction of both arches.

The existing prosthetic restorations were removed, followed by extraction of hopeless teeth and explantation of compromised implants placed approximately 20 years ago. After thorough surgical debridement, new implants (SGS Dental) were placed in prosthetically driven positions, including tilted posterior implants where required to optimize the available anatomy and support full-arch rehabilitation.

Simultaneous hard-tissue augmentation (Botiss cerabone, maxgraft, Jason pericardium membrane, and PRF) was performed to reconstruct deficient peri-implant sites and provide a favorable foundation for long-term rehabilitation.

Following implant placement, a fully digital workflow (SHINING 3D Aoralscan Elite with integrated dental photogrammetry) was used to accurately capture implant positions. Immediate screw-retained fixed provisional restorations (Bredent BioniCut) were delivered within 24 hours, restoring function and esthetics during the healing phase.

This case highlights that full-mouth implant rehabilitation is not simply about replacing teeth and implants. In severely compromised situations, predictable treatment requires a comprehensive approach combining explantation, tissue reconstruction, prosthetically driven implant positioning, and immediate fixed rehabilitation.

The definitive prosthetic rehabilitation is planned after a 6-month healing period, following osseointegration and maturation of the reconstructed hard and soft tissues.