Implant AOX
This patient already had a full-arch implant-supported bridge in the upper arch and two implant crowns in the lower arch. Although the upper restoration was functioning well, she wanted a highly customized redesign that would change both the tooth shape and the way the restoration was divided.
A functional full-arch bridge that no longer matched the patient's preferences
The patient was an existing implant patient with two implant crowns in the lower arch and an upper full-arch implant-supported bridge that had previously been completed in Brazil. The upper restoration was functioning well, and she had initially been satisfied with it.
At a later checkup, however, she explained that she had become unhappy with the shape of the teeth and with the fact that the upper restoration was designed as one connected piece without traditional gaps between the teeth.
Her request was unusual for a full-arch implant restoration: she wanted the upper teeth divided into several separate sections so she could pass floss between them more like individual teeth.
The implant positions supported one connected bridge—not several independent sections
The existing upper All-on-X-style bridge was clinically functional, and there was no indication that the entire restoration needed replacement because of structural failure. The main limitation was the position and distribution of the existing implants.
Most of the implants were concentrated around the premolar region. That arrangement worked for the original full-arch bridge, but it did not provide enough independent support to safely divide the restoration into separate front and back sections.
Creating several independent restorations required implant support in the correct positions throughout the arch. After the limitations of the existing configuration were reviewed, the patient remained committed to pursuing a segmented design.
Four additional implants created support for a six-piece segmented restoration
The existing upper full-arch bridge was removed so the implant configuration could be evaluated and modified. One existing implant that was not being utilized was removed, and four new implants were placed to create better support across the arch.
- Two additional implants were placed toward the front of the arch
- Two additional implants were placed toward the back of the arch
- The new implants were allowed to heal for approximately three months
- The arch was digitally scanned in sections after healing
The final reconstruction consisted of six separate pieces: one individual implant crown on each side and four implant-supported bridge sections through the center of the arch.
The segmented design created several spaces between the restorations where the patient could pass floss. She was extremely pleased with the result, and the case remained stable at approximately three years of follow-up.
Before & after treatment
These images show the case before treatment and after the customized full-arch implant reconstruction was completed.
Learn more about dental implants, full-arch treatment, and advanced implant care at Ipswich Bay Dental in Ipswich, MA.
Why most All-on-X restorations are one connected bridge
All-on-X treatment is typically designed around a single fixed full-arch restoration supported by a strategically positioned group of dental implants. Connecting the teeth into one restoration helps distribute chewing forces across the implant system and allows an entire arch to be replaced using fewer implants than would be required to support every tooth independently.
Because the prosthesis is connected, a traditional full-arch implant bridge usually does not have normal flossable spaces between every individual tooth. Patients are instead taught specialized cleaning techniques for maintaining the area beneath and around the restoration.
A segmented design can be considered in selected cases, but enough implant support must be present in the correct locations. If implants were originally positioned for one connected bridge, additional implants may be required before the restoration can safely be divided into smaller independent sections.
This case represents an unusually customized solution based on one patient's specific preferences. It is not the standard approach for All-on-X treatment, and for most patients a traditional connected full-arch restoration remains an effective and predictable option.
All-on-X and segmented implant bridge FAQ
Are All-on-X teeth normally one connected piece?
Yes. Most All-on-X restorations are designed as a single fixed bridge spanning the dental arch. The implants work together to support the restoration and distribute biting forces across the arch.
Why aren't there normal gaps between every tooth in an All-on-X bridge?
The visible teeth are part of one connected prosthetic structure rather than separate natural teeth. The tooth shapes can look individual, but the restoration underneath remains connected.
Can I floss between the teeth of an All-on-X bridge?
Generally, not between every individual tooth in the same way as natural teeth. Patients may use floss threaders, specialized implant floss, interdental brushes, oral irrigators, and other cleaning methods recommended by their dental team.
Can an All-on-X bridge be divided into separate sections?
In selected cases, yes. The number and position of the implants must provide adequate support for each independent section. Additional implants may be required when the original implants were positioned for a single full-arch bridge.
Why did this patient need four additional implants?
The original implants were concentrated primarily around the premolar areas. That configuration supported the connected bridge, but not separate anterior and posterior restorations. Additional implants were therefore placed in both the front and back regions.
Does every patient need this many implants for All-on-X treatment?
No. This was an unusual case in which the patient specifically requested multiple separate restorative sections. Traditional All-on-X treatment is designed around a strategic number of implants supporting one connected full-arch restoration.
Can the shape of the teeth on an existing All-on-X bridge be changed?
Often, yes. The prosthesis may be redesigned or replaced depending on its condition and the underlying implant system. Changing the restoration is generally simpler than changing the number, location, or distribution of the implants.
Is a segmented implant bridge better than a traditional All-on-X bridge?
Not necessarily. A segmented design may suit certain highly specific restorative or hygiene preferences, but it requires sufficient implant support and more complex planning. For most patients, a traditional connected full-arch restoration remains an effective solution.
Can an existing All-on-X case be redesigned years later?
Potentially. The health, position, stability, and compatibility of the existing implants must be evaluated along with available bone and the patient's restorative goals. Some cases may only require a new prosthesis, while others may require additional implant surgery.
Full-arch implant treatment should be customized to the patient
There is no single restoration design that is right for every patient. At Ipswich Bay Dental, a comprehensive implant evaluation can help determine which approach offers the best balance of function, appearance, hygiene, and long-term stability for your individual needs.
Schedule an Implant Consultation