Resident Jacksonville University Katy, Texas, United States
Purpose of the Study: Patients presenting with a terminal dentition require careful integration of a multi-disciplinary approach. The 2017 World Workshop classification of periodontal and peri-implant diseases provides a standardized framework for clinicians to better stage, grade, and prognosticate outcomes. When integrated with digital workflows and prosthetic-driven planning, it improves predictability and facilitates the transition of patients from compromised dentition to implant-supported dentition.
Methods: This Table Clinic introduces an efficient, clinically applicable prosthetic-driven treatment planning algorithm for patients with terminal dentition. A central feature of this approach is the integration of the “Smart Denture” protocol—an easy, chairside, same-day conversion technique that streamlines the transition to implant-supported prostheses following implant placement on the same day.
Results: A narrative review of the current literature was performed, including recent classifications in periodontology and comparative outcomes of tooth-supported versus implant-supported full-arch prostheses. These findings were integrated with clinical case presentations to construct a stepwise prosthetic-driven treatment planning. The proposed algorithm emphasizes accurate staging and grading as prognostic markers, incorporates digital workflow for precise planning, and outlines a predictable method for immediate denture conversion after implant placement. Case examples illustrate improved functional rehabilitation with reduced patient morbidity and patient satisfaction when adopting this approach.
Conclusion: By combining periodontal classification, digital workflows, and the Smart Denture protocol, clinicians can achieve efficient, patient-centered, and predictable outcomes in managing terminal dentition. This framework offers a practical pathway from hopeless dentition to immediate, functional, and esthetic implant-supported rehabilitation.
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Donos N, Mardas N, Goldoni M, et al. Efficacy of tooth-supported compared to implant-supported full-arch removable prostheses in patients with terminal dentition: A systematic review. J Clin Periodontol. 2022;49(Suppl 24):224-247. doi:10.1111/jcpe.13477
Tomasi C, Albouy J-P, Schaller D, Camino Navarro R, Derks J. Efficacy of rehabilitation of stage IV periodontitis patients with full-arch fixed prostheses: Tooth-supported versus implant-supported—A systematic review. J Clin Periodontol. 2022;49(Suppl 24). doi:10.1111/jcpe.13511
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Ravidà A, Qazi M, Troiano G, et al. Using periodontal staging and grading system as a prognostic factor for future tooth loss: A long-term retrospective study. J Periodontol. 2020;91:454-461. doi:10.1002/JPER.19-0390
Kornman KS, Papapanou PN. Clinical application of the new classification of periodontal diseases: Ground rules, clarifications and “gray zones.” J Periodontol. 2020;91:352-360. doi:10.1002/JPER.19-0557
Papaspyridakos P, Bedrossian A, De Souza A, Bokhary A, Gonzaga L, Chochlidakis K. Digital workflow in implant treatment planning for terminal dentition patients. J Prosthodont. 2022;Epub ahead of print. doi:10.1111/jopr.13510
Mitrani R, Papaspyridakos P, Bedrossian EA, Goldberg J, Tsigarida A, Chochlidakis K. Treatment planning algorithm for patients with a terminal dentition. J Prosthet Dent. In press.
