Computer-Guided Full-Arch Maxillary Rehabilitation Using the All-on-6 Protocol in a Patient with Severe Generalised Periodontitis

Abstract

Severe generalised periodontitis may result in terminal dentition associated with progressive alveolar bone destruction, pathological tooth migration, impaired mastication, compromised phonetics and reduced facial aesthetics. Rehabilitation in these patients remains challenging, particularly in the maxillary arch, where reduced bone density and sinus pneumatisation can complicate implant positioning. This case report describes comprehensive rehabilitation of a 56-year-old male patient with severe generalised periodontitis using a computer-guided All-on-6 maxillary implant protocol with immediate loading. After clinical examination, panoramic radiography, cone-beam computed tomography (CBCT), digital intraoral scanning and prosthetically driven virtual planning, the remaining hopeless maxillary teeth were extracted, the sockets were debrided, and six endosseous implants were placed using a stereolithographic surgical guide. Posterior implants were planned with distal angulation to optimise anterior-posterior spread and avoid extensive sinus augmentation. Primary implant stability of 35–45 Ncm permitted immediate screw-retained provisionalisation within 24 hours. Definitive rehabilitation was completed after approximately four months using a CAD/CAM-milled titanium framework and screw-retained hybrid prosthesis. Follow-up at one week, one month, three months, six months and one year demonstrated stable peri-implant soft tissues, stable crestal bone levels, absence of peri-implant radiolucency, no biological or mechanical complications, satisfactory prosthetic function and high patient satisfaction. No complications were observed during the reported follow-up period. The reported case indicates that, with careful case selection, digital planning, guided surgical execution and strict maintenance, an All-on-6 protocol can support predictable full-arch maxillary rehabilitation in a periodontally compromised patient. Long-term monitoring remains necessary because previous severe periodontal disease increases the need for continued peri-implant maintenance.