A staged full mouth rehabilitation is a plan delivered in separate clinical phases across months or years rather than one continuous treatment block. Alexandru’s file covers four of them, running from implant placement in July 2022 to a reconstruction stage under general anaesthesia in 2025 and a digital renewal in August 2026. This case study follows that dated record at International Plus, which has treated 200,000+ patients from 140+ countries since 2014.
Key Takeaways
- The challenge: Maintain a complex implant and bridge reconstruction across four years, each phase planned from the previous phase’s record.
- The solution: Four stages: five implants with 26 zirconia units in 2022 to 2023, a 2025 reconstruction under general anaesthesia, then a 2026 renewal of 24 zirconia units on multi unit abutments.
- Technical highlights: Apical resection at tooth 21, segmented bridge design with planned connection cuts, an implant passport for traceability.
- The outcome: A rebuilt lower arch delivered in August 2026, the upper arch returned to the laboratory, plus a night guard. Individual results may vary.
What Does a Four Year Treatment Record Actually Show?
A four year record shows how a reconstruction behaves under load, not only how it looked on delivery day. Alexandru’s file spans four dated treatment cards from 28 July 2022 to 26 August 2026, plus two prosthetic laboratory logs. Each phase reads as part of a sequence rather than a single event.
Tooth 21 shows why that matters. The 2022 card records an apical resection at that tooth and the 2025 card lists the same tooth among the planned extractions. Published outcome studies of apical surgery use a minimum follow up of four years for exactly this reason (Hussain O, et al., 2026). Apical surgery is worth attempting on a strategically placed anterior tooth but the approach is not the right choice for every root because a tooth carrying bridge abutment load can lose structural viability even after the periapical lesion resolves (Anand A, et al., 2026).
| Year | Stage | Recorded work | Technical note |
| 2022 | Implants, first prosthetics | 5 implants, extraction, 26 zirconia units, night guard | Bridge and implant options both evaluated; apical resection at tooth 21 |
| 2023 | Prosthetic completion | Abutment uncovering, closed tray impression, plastic and dentine try ins | Implant passport issued to the patient |
| 2025 | Reconstruction stage | 4 extractions including teeth 21 and 34, root canals, filling | Second session under general anaesthesia; segment cuts planned |
| 2026 | Digital renewal | Multi unit abutments, two plastic try ins, 24 zirconia units, night guard | Facial and 3D scanning; lower arch completed, upper arch to laboratory |
Bottom line: each row was planned from the row above it.
2022 to 2023: Five Implants, an Apical Resection and a Four Appointment Delivery
The opening phase set the foundation. The July 2022 card records five implants and one extraction, then lists 26 zirconia crown units across a 6 and 7 grid in both arches. An apical resection at tooth 21 and a night guard appear alongside them and a note confirms that a bridge solution was weighed against implants before placement.
Placing dental implant treatment in Istanbul rather than extending a bridge changes where occlusal load lands for the next decade so our Diagnostic Council reviews abutment prognosis against available bone volume before either option is confirmed. Twenty year pooled data put implant survival at high levels once integration is achieved (Kupka JR, et al., 2024). Delivery followed in November 2023 across four working days: implant tops uncovered on 2 November, a closed tray impression to the technician on 3 November, then a plastic try in and a dentine try in on 6 and 7 November. We prefer that separation because an error caught at the plastic stage costs one laboratory cycle rather than the whole framework as in Marilyn’s rehabilitation combining implants and root canals. One detail carries long term value: an implant passport was issued to Alexandru.
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2025: A Reconstruction Stage Planned Under General Anaesthesia
The July 2025 card opens with a reconstruction surgery note and records four extractions that included teeth 21 and 34, alongside root canal treatments marked at three difficulty grades plus a further four canals completed during the first operation. A dental filling is also recorded. The second session carries a general anaesthesia note.
General anaesthesia was the planning decision that held the stage together. Combining extractions, root canal treatment by endodontic specialists and prosthesis removal in one session reduces the number of separate surgical events an international patient travels for. Three explicit surgical instructions also appear on that card. The lower jaw was to be cut at the 34 and 41 region with the existing prosthesis removed beforehand. The connection between teeth 43 and 42 was to be divided and the upper bridge across teeth 21, 23, 24 cemented separately. Our surgical team writes those cuts into the plan before the operating day.
Why Were the Bridges Planned as Separate Segments?
Segmenting a long bridge means dividing one continuous span into shorter independent units so that each segment seats on its own path of insertion. Alexandru’s 2025 notes specify two division points in the lower arch and a separately cemented upper segment covering teeth 21, 23, 24. That design changes both fit tolerance and load distribution.
Finite element work comparing complete against segmented full arch frameworks shows that segmentation alters how force reaches individual abutments (Anitua E, et al., 2026). Shorter segments are also easier to seat passively and passive fit remains the practical benchmark for implant supported frameworks (Kamel ME, et al., 2024). Unlike a one piece fixed Toronto bridge prosthesis on a single titanium framework as in Constant’s screw retained zirconia bridge case, a segmented design accepts more cement lines in exchange for easier seating and simpler repair.
2026: Multi Unit Abutments, Face Scanning and a Staged Try In Protocol
The renewal phase ran across six days in August 2026. Implants were checked and multi unit abutments fitted on 21 August. A plastic try in followed on 22 August and a second plastic try in on 23 August. By 26 August the lower arch was completed while the upper arch returned to the laboratory. A night guard was recorded again.
Multi unit abutments raise the connection above gum level so the framework seats on a machined platform rather than on the implant and laboratory testing supports their role in accuracy (Stimmelmayr M, et al., 2017). For 2026 the record specifies 24 zirconia units, delivered as zirconia dental crowns across a 6 and 6 grid under a one by one shaping selection with nine units cemented. Planning used a facial scan from our SHINING 3D MetiSmile scanner with 3D intraoral capture, a combination whose accuracy has been measured directly (Al Hamad KQ, et al., 2025) and the same route appears in our complete digital full mouth implant rehabilitation in Istanbul. Megagen is named as the provisional material; the implant system itself is not identified in the file.
The Outcome and What Long Term Follow Up Adds
Alexandru finished the August 2026 phase with a completed lower arch, an upper arch back at the laboratory for adjustment and a night guard for parafunctional protection, the same measure used in Bohdan’s severe bruxism rehabilitation. Individual results may vary and every phase depended on findings recorded before it.
What this staged full mouth rehabilitation demonstrates is maintenance, not a single transformation. Published maintenance protocols treat scheduled review and component records as part of implant treatment rather than an optional extra (Soares PM, et al., 2024). Four years on, the 2023 implant passport told the 2026 team which components sat under the framework before a single screw was loosened. This is the standard behind International Plus: official Ministry of Health authorization, 5,504+ verified reviews at 4.8/5 and a written record kept across years, not appointments.
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Frequently Asked Questions
What is a staged full mouth rehabilitation?
A staged full mouth rehabilitation divides a mouth reconstruction into separate clinical phases delivered over months or years. Each phase is planned from what the previous phase recorded so surgery and healing feed into prosthetic delivery and later renewal rather than one fixed procedure.
Why would dental treatment be carried out under general anaesthesia?
General anaesthesia allows several procedures to be combined in one session, which reduces the number of separate surgical appointments a patient needs. In Alexandru’s 2025 stage that grouping covered extractions alongside endodontic work and prosthesis removal, a decision made by the clinical team after medical assessment.
Why is a long bridge sometimes divided into separate segments?
Dividing a long span into shorter independent segments makes each unit easier to seat passively and changes how chewing force reaches abutments. Shorter segments are simpler to repair later and the trade off is more cement lines so the decision depends on span length.
What is an implant passport?
An implant passport is a document listing the implant components placed in a patient’s mouth. Alexandru received one in 2023. When his restorations were renewed three years later, that record identified the components under the framework before any work began.
Reviewed by Dr. Emre Çolak
References
- Hussain O, et al. Clin Oral Investig. 2026. PMC13500407
- Anand A, et al. Bioinformation. 2026. PMC13252328
- Kupka JR, et al. Clin Oral Investig. 2024. PMC11416373
- Anitua E, et al. Front Bioeng Biotechnol. 2026. PMC13171742
- Kamel ME, et al. BMC Oral Health. 2024. PMC11481720
- Stimmelmayr M, et al. J Prosthodont Res. 2017. PMID: 28188110
- Al Hamad KQ, et al. J Prosthodont. 2025. PMC12378954
- Soares PM, et al. J Prosthet Dent. 2024. PMID: 36535881
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This content is written, reviewed, and approved by the International Plus Medical Review Board to ensure clinical accuracy and adherence to strict editorial standards. All medical information is regularly monitored, audited and updated in light of the latest scientific advancements.
However the information provided here is for general informational purposes only and cannot be used for self diagnosis or making individual health interpretations. Results of medical treatments depend on individual anatomy and the unique healing process of each patient. This information should not replace a personal consultation with a qualified healthcare professional. To understand the best options for your specific needs and to receive a personalized treatment plan, we invite you to book a free consultation with the expert medical team at International Plus.
International Plus was established from scratch in 2014 with the sole purpose of providing a world class center for plastic and cosmetic surgery by SAMİLSAN SAĞLIK HİZMETLERİ TURİZM DANIŞMANLIK TİCARET LİMİTED ŞİRKETİ International Plus has developed a worldwide reputation for its unique treatments and techniques. With over 10 years of experience, our talented medical experts are among the best in their respective fields. You are our priority. We are convinced that good communication between you and your surgeon is essential when planning your treatments. We offer realistic advice and the most suitable treatments for you.
