Guided STAGED Full Arch Maxilla with Ritter Spiral Implants

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Posted on By Maurice Salama In Full Arch & Dentures

Patient presents with Failing dentition. We maintain 3 teeth to support temp bridge during implant osseointegration with delayed Bone reduction and transition to implant supported restoration.

Healing after 4 months
Bone reduction guide

Chisels for bone removal
Ridge after Teeth removal

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Prosthetic Phase

Immediate Load


Dr Salama, so the implants here where placed before the bone reduction..deep in their anticipated future location? then the bone reduction was done later after integration?



Ernest, yes. Notice the sublime healing and Bone that filled around the implants when they remained SEALED by the Flap. regards Dr. Salama


Thanks for posting Maurice. I like the low(er) risk of placing the implants prior to loading. What was the initial temp bridge made out of? Did it hold up well over the course of healing? Kurt Doolin


Kurt; Yes, Printed PMA and reinforced. Held up for 6 months. The Teeth did their job and allowed for DELAYED loading but also to stabilize the Guides, secure the Implant Temp and establish the bite. regards Maurice


Yes! like the sequencing of the case. Healing is always better in a closed or sealed environment for sure. thank you for sharing Dr. Salama Ernest


Welcome my friend...SOMETIMES, keeping a few teeth makes the final result better even if it requires one additional surgery and time.....Dr. Salama


dr salama
it was anpleasure meeting you this weekend at versah conference in phoenix. honestly, i owe my career and practice to you and the excellent presenters you have here on dentalxp. i think ive been on for about 6-7yrs, ill ask tyler. but yeah, thank you.
mice aproach to this case. cant wait to try this too.


Very welcome my friend. See you again soon. Regards Dr. S


Mo why not keep the roots that you extracted. Great case all round and superlative planning and delivery


Howie, VERY Good Question. Since the roots were extremely mobile and short after the planned bone reduction we decided to remove them. BUT, we did discuss it!! The case was a "perio" case so the esthetics required "PINK". Regards Mo



Nice work - case reminds me some past techniques we used to call “heal then load” style

Having said that tell me why you decided to treat the case this way instead of reduce place and load ? could involve the presentation of the mandible and what is your long-term plan for the mandible as well