Patient & Goals **“Jordy,” 51 y/o smoker (3–5 cig/day), history of severe periodontitis
Refused removable dentures; desired fixed full‑arch prostheses
Adequate vertical prosthetic space (11.5–14 mm) and no excessive gingival display on smiling
Treatment Plan Immediate‑loading full‑arch:
6 implants each in maxilla and mandible
Straumann BLX system (4.0×12 mm in maxilla; mix of 4.0×10 mm & 3.5×12 mm in mandible)
Straight abutments throughout
Guided surgery:
Maxilla: two sequential guides—(a) duplicate provisional denture base, (b) fully guided drill/placement
Mandible: three guides—(a) provisional‑duplicate guide, (b) bone leveling guide, (c) implant‑placement guide
Key References EAO 2021 Consensus: Timing of loading (immediate vs. delayed) does not affect implant survival; immediate loading yields higher patient satisfaction.
Surgical & Prosthetic Workflow Day 0 (Surgery)
Fix and remove sequential guides
Level bone under guidance (mandible)
Place all 12 implants with guided templates
Day 1
Deliver PMMA full‑arch provisionals based on digital plan
Verify emergence profile, occlusion, and esthetics intra‑ and extra‑orally
Definitive Prostheses
Delivered ~4 months later after healing
Outcomes & Take‑Home Messages High patient & surgeon satisfaction with immediate fixed restorations vs. removable dentures
Soft‑tissue support can be sculpted by the provisional prosthesis from Day 1
No compromise in implant survival or marginal bone loss compared to delayed loading
Clinical tip: If anatomy, primary stability, and patient factors allow, “Why not immediate loading?”