A full mouth rehabilitation does not always mean removing every tooth. For Marilyn from Germany, an international patient who came to International Plus for a complete oral reset, the plan protected several healthy natural teeth while replacing the rest. This case study follows a full mouth rehabilitation with implants and root canals, a multidisciplinary route that paired endodontics with implant surgery and a mixed prosthetic design planned on a digital face scan. International Plus has treated more than 200,000 patients from 140+ countries since 2014.
Key Takeaways
- The challenge: A deteriorated dentition where some teeth were salvageable and others were not so a single extract everything plan would have sacrificed viable natural teeth.
- The solution: A full mouth rehabilitation with implants and root canals that placed roughly six implants per arch while saving about eight natural teeth through endodontic treatment.
- Technical highlights: Guided implant surgery with PRF, microscope assisted root canals including retreatment and a mixed prosthesis of monolithic zirconia and Emax crowns planned on a digital face scan.
- The outcome: A fixed, natural looking result colour matched to shade 0M1 and protected by a night guard. Individual results may vary.
Marilyn’s Story: A Reset That Kept Her Own Teeth
Marilyn from Germany wanted a durable, fixed result without losing teeth that could still serve for years. Arriving as a German speaking international patient, Marilyn planned the whole rehabilitation end to end before travelling to Istanbul in 2025. That single priority shaped every decision the restorative and surgical team made: rebuild the entire mouth without over treating it.
The request carried a real clinical trade-off. Replacing every tooth with implants is simpler to plan, yet a natural tooth with a healthy root and sound bone often outlasts the decision to remove it. Preserving a viable natural tooth is widely preferred over extraction when its prognosis allows (Zanza A, et al., 2023), a principle our clinic weighs for every full mouth case. Weighing simplicity against preservation, the team committed to the harder path of saving what could be saved.
Diagnosis and Treatment Plan: Deciding Which Teeth to Save
Planning began with layered imaging because deciding which teeth to keep demands more than a single view. The team captured a 2D panoramic radiograph for an overview, a 3D CBCT scan (cone beam tomography that maps bone volume and root anatomy in three dimensions), a digital face scan and an intraoral scan. The Diagnostic Council, our multidisciplinary review of every complex plan, then graded each tooth’s prognosis before any treatment began.
The Council drew a clear line between teeth worth saving and teeth beyond repair. Structurally sound teeth with treatable infection were routed to endodontics while unrestorable teeth were marked for extraction and implant replacement. The team chose a staged protocol over immediate loading because loading decisions in complex cases turn on bone quality and the stability reached at placement (Morton D, et al., 2018). Combining different prosthetic materials across a rehabilitated mouth is an established workflow when the clinical picture calls for it (Rajaraman V, et al., 2022). The roadmap was explicit: save the viable teeth, place implants where teeth were lost, then unify everything under one prosthetic design, the same integrated thinking behind our comprehensive rehabilitation combining surgery, endodontics and prosthodontics.
Saving the Natural Teeth: Endodontics Alongside Implant Surgery
Where teeth were structurally sound but infected, the team chose root canal treatment over extraction. Roughly eight natural teeth received endodontic treatment, the removal of infected pulp followed by cleaning and sealing of the canal, and some of these were retreatment of earlier failed root canals. Nonsurgical retreatment is a predictable way to preserve a previously treated tooth rather than extract it (Zanza A, et al., 2023) and magnification supports precise location and cleaning of the canal system during that work (Del Fabbro M, et al., 2016). This microscope assisted endodontic care let Marilyn keep her own roots in the bone.
In parallel, the surgical phase replaced the teeth that could not be saved. Using guided surgery, where a CBCT derived guide directs each implant along a planned path, the team placed roughly six implants per arch to an insertion torque target of 35 to 45 N/cm, the rotational force that measures how firmly an implant grips bone at placement. PRF, platelet rich fibrin concentrated from Marilyn’s own blood, was applied to support healing of the extraction and implant sites (Al-Maawi S, et al., 2021). Over roughly six months the fixtures underwent osseointegration, the process where living bone fuses directly to the implant surface, the same biology we explain in our overview of osseointegration in All on 4 and All on 6 systems. Marilyn healed with her natural teeth still in function while the implants integrated quietly beneath the gum.
The Prosthetic Phase: Mixed Zirconia and Emax on a Digital Face Scan
Once integration was confirmed, the restorative phase unified natural teeth and implants under one facially driven design. The implant sections were restored with screw retained monolithic zirconia, roughly 25 units cut from single high strength blocks, chosen because monolithic zirconia removes the layered porcelain that fractures first and gives full arch prostheses strong survival (Papaspyridakos P, et al., 2025), the same material we use in full mouth zirconia rehabilitations with sinus lift and in a fully digital full mouth implant rehabilitation. The screw retained design keeps that work retrievable for maintenance. On the preserved upper incisors in the 21 and 12 region, the team placed Emax lithium disilicate crowns, a glass ceramic whose translucency suits the smile zone and whose survival in anterior single crowns is well documented (Sailer I, et al., 2015).
Shade and shape were not left to chance. Using the digital face scan captured at diagnosis (MetiSmile), the team designed the smile against Marilyn’s facial proportions, a facially driven approach that improves aesthetic predictability (Watanabe H, et al., 2022). A trial smile confirmed the plan before any final restoration was milled and the definitive work was matched to shade 0M1 in our DSD-planned smile transformation workflow, combining zirconia dental crowns on the implants with Emax where natural teeth remained.
| Implants | Roughly six per arch, guided placement, PRF | Replace unsalvageable teeth with a fixed foundation |
| Endodontics | About eight root canal treatments, some retreatment | Preserve viable natural teeth in the bone |
| Implant prosthesis | Around 25 units, screw retained monolithic zirconia | Strength across the arch plus retrievability |
| Anterior crowns | Emax on upper incisors (21, 12 region) | Natural translucency in the smile zone |
| Smile design | Digital face scan, shade 0M1, trial smile approval | Facially driven, previewed result |
| Aftercare | Night guard | Manage parafunctional load on the new work |
This mixed design meant Marilyn’s root canal treatment by endodontic specialists and her new dental implant treatment in Istanbul worked as one occlusion rather than two separate repairs.
The Result: A Fixed Smile Built Around Her Own Teeth
Marilyn left with a fixed, unified dentition, several natural teeth preserved and the rest restored on implants, colour matched to shade 0M1. A night guard, a removable splint worn during sleep, was delivered to absorb the involuntary clenching and grinding that can overload a newly restored mouth, the same protective step behind our full mouth rehabilitation for severe bruxism and tooth loss and our screw retained zirconia bridge on a milled bar. Keeping natural roots alongside implants gave Marilyn a more conservative reconstruction than a full clearance would have delivered. Combining natural teeth and implants under one prosthesis is an established restorative strategy (Rajaraman V, et al., 2022). Individual results may vary, and every plan depends on the prognosis of the specific teeth involved.
This full mouth rehabilitation with implants and root canals reflects why International Plus builds each plan around diagnosis rather than a single default procedure. With a 4.8/5 rating across more than 5,504 reviews and Ministry of Health authorisation, the clinic pairs multidisciplinary planning with an in house digital laboratory so that surgery and endodontics answer to the same prosthetic plan.
Frequently Asked Questions
Can natural teeth be saved during a full mouth rehabilitation?
Yes. When a tooth has a healthy root and treatable infection, root canal treatment can preserve it instead of extraction. In a full mouth rehabilitation, viable natural teeth are kept and restored with crowns while only unsalvageable teeth are replaced by implants, based on each tooth’s prognosis at diagnosis.
Why combine implants with root canal treated teeth?
Combining implants with saved natural teeth is more conservative than removing everything. Natural teeth with good root and bone support can serve for years so preserving them through endodontics avoids unnecessary surgery. Implants then replace only the teeth that cannot be restored and a unified prosthetic design brings both into one occlusion.
What is the difference between monolithic zirconia and Emax crowns?
Monolithic zirconia is a very strong ceramic milled from a single block, well suited to load bearing implant sections and long spans. Emax or lithium disilicate, is a glass ceramic prized for translucency in the visible smile zone. In this case, zirconia restored the implants and Emax was placed on the natural upper incisors.
How long does a full mouth rehabilitation with implants and root canals take?
Timelines vary by case. When implants are placed with a staged protocol, osseointegration typically needs around six months before final restorations are fitted while endodontic treatment on the preserved teeth runs alongside. The exact schedule for a full mouth rehabilitation with implants and root canals depends on healing, the number of teeth involved and the prosthetic plan confirmed by the Diagnostic Council.
Reviewed by Dr. Muhammed Kerem Işıkhan
References
- Morton D, et al. Clin Oral Implants Res. 2018. PMID: 30328196
- Rajaraman V, et al. J Adv Pharm Technol Res. 2022. PMC9836150
- Zanza A, et al. Clin Cosmet Investig Dent. 2023. PMC10612510
- Del Fabbro M, et al. Cochrane Database Syst Rev. 2016. PMC6461161
- Al-Maawi S, et al. Int J Implant Dent. 2021. PMC8684569
- Papaspyridakos P, et al. J Prosthodont. 2025. PMID: 39136214
- Sailer I, et al. Dent Mater. 2015. PMID: 25842099
- Watanabe H, et al. Dent Clin North Am. 2022. PMID: 36216447
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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.
Muhammed Kerem provides comprehensive dental care centered on practical solutions and exceptional patient outcomes for travelers seeking quality treatment in Istanbul.
