The FP-3 Revision

Teeth lost to advanced periodontal disease, and the fixed implant reconstruction that replaced them in both jaws — an FP-3, carrying the lost gum in ceramic, seen in the mouth and on the radiograph.

Some cases arrive with implants that cannot be restored.

Not damaged, not failing. Integrated perfectly, and pointing the wrong way. Severely malaligned, so that the screw access emerges through the front of the teeth rather than behind them, and conventional restoration is simply not available.

Removing them is surgery nobody wants. So the problem has to be solved above the bone rather than in it.

The answer is a technique he developed and published for exactly this situation: the correction of severely malaligned implants in an FP-3 design.

A primary framework is built first, and its job is not aesthetic. It corrects the angulation. It takes the trajectories the implants actually have and converts them into the trajectories the teeth need, so that everything above it can be made properly rather than compromised around a problem.

This is another framework design of Dr. Reshad's. A full-contour wax-up is made first and the whole shape of the finished teeth is designed in it. That wax-up is then cut back to make the framework, and ceramic is layered on top of what remains.

Another design, another system, to tackle the variety of implant angles, complications and revisions that arrive. Every case is unique, and every case is dealt with by a bespoke design of framework to suit that individual patient. Only a prosthodontist can do that.

Individual bridges are then cemented onto that framework.

The result is a prosthesis that looks and feels natural, and a patient who functions well, on implants that nobody would have placed that way by choice.

The original version of this design was created almost twenty years ago, when there was no other answer available.

What is used now is not what was used then. The current framework is cobalt chromium, with ceramic built on top of it, still performing the same correction of the implant angulations but in materials that have moved on considerably since the technique was first published.

That is how a technique should age. The principle holds. The materials change.

This patient's definitive restorations are zirconia carried on a titanium bar, in both jaws, placed and loaded immediately after the failing teeth came out. What sets the case apart is where the upper implants go.

He received pterygoid implants, which means they are specialized implants in the back of the mouth, in the upper jaw. They allow additional support for the system.

They allow longevity in the system, because if anything fails in front of them we will always have two implants anchored in the very strong skull base bone in the back. That will mean that even twenty years later, if we have a failure, we will still have enough implants all around to function if we need to transition to additional implants in the distant future.

Finally, having implants so far back allows the maximum chewing surface for patients, with possibly the full complement of teeth, with minimal risk.

But you need to know what you are doing, and that is what we do at Dr. Reshad's office.

Precision and advanced dentistry for optimal function and longevity.

Full-arch implant dentistry can give you a smile that lasts the rest of your life — or a decade of loose screws, bad odor and remakes. The difference almost always comes down to decisions made before the first drill touches bone. After 30 years and thousands of full-arch cases, this is exactly how Dr. Reshad plans a case, what he watches for, and how he prevents the problems most patients never see coming until they're living with them.

Every full-arch case Dr. Reshad plans sits on a three-way tension: function, biology and aesthetics. Early in his career he leaned toward aesthetics — how the case would look was what drove his decisions. Thirty years and thousands of cases later, he has moved hard toward the functional corner of that triangle, and he can tell you exactly why: without proper function, a restoration doesn't last. And without longevity, aesthetics is irrelevant, because the teeth have already fractured, loosened or been remade by the time anyone would admire them. Everything that follows comes from that one shift in priority.

Most of what follows are decisions your surgeon and restorative dentist have to make before a single implant goes into bone — not adjustments made afterward. Get them right and a full-arch restoration can genuinely last the rest of your life. Get even one of them wrong, and you can end up exactly where the patient below did.

A patient came to Dr. Reshad after an all-on-4 restoration elsewhere left him in daily discomfort: his upper prosthesis was constantly loosening, his lower one gave off a persistent odor he couldn't get rid of no matter how carefully he cleaned it, and he'd bite his own cheek and tongue routinely. He'd even been given a removable partial denture to snap onto his "fixed" restoration — because he hadn't been given enough teeth to chew with in the first place. When the lower prosthesis was finally removed, two of his four implants had already failed. The underlying cause wasn't bad luck. It was a restoration shaped and positioned in a way that trapped plaque against the tissue from day one, on implants that had never been distributed to bear the load he was putting on them.

A second case, referred to Dr. Reshad by a lab technician, was almost the mirror image: implants placed too far toward the palate, with so little lip support that the lab had to build a bulky shelf of pink material — a "ridge-lap" — just to fill the space in front of the implants and give the patient a normal-looking smile. It looked reasonable in a photograph. In the mouth, that ridge-lap was almost impossible to keep clean, and the case was failing on hygiene grounds within a couple of years.

Both patients had "had implants placed." Neither had had a plan. That's the difference this section is about.

Every full-arch restoration has to rise up out of the gum tissue somewhere. How it does that — the angle, the contour, the surface the tissue actually touches — determines whether you can keep it clean for the next 20 years, or whether it slowly, quietly causes problems underneath it that you can't see or reach.

The clearest example Dr. Reshad can give is a patient who came in wearing a denture and wanted a fixed restoration. She had plenty of bone in her existing ridge, which meant the "obvious" plan — just place implants where the bone already was — would have worked from a surgical point of view. He didn't do that. Instead, the case started with a full denture setup to establish exactly where her teeth needed to be for the right lip support, speech and bite. Only once that was locked in was it calculated how much bone had to come down to let the final teeth emerge from a beautifully flat, hygienic ridge — using a surgical guide stabilized on her remaining posterior teeth for accuracy.

That case needed a substantial amount of bone reduction — more than most clinicians are comfortable doing. Fourteen years later, her restoration still has the same flat, hygienic emergence it had on day one. Compare that to a patient who complains constantly of food trapped at the base of their teeth: almost always, that's a steep emergence angle, not a hygiene failure on the patient's part. The reduction itself is guided rather than estimated in the moment — a stabilized surgical guide translates the wax-up directly onto the bone, so the result is exact.

If shape and contour are about hygiene, this section is about survival. In three decades of full-arch dentistry, the cantilever — the unsupported extension of a bridge past its last implant — is the single biggest reason restorations fail. It is Dr. Reshad's biggest enemy in this kind of dentistry, and it deserves more attention than almost anything else in the planning process.

A classic all-on-4 or all-on-5 design places four or five implants between the nerves of the lower jaw, with the restoration cantilevering out past them on both sides to reach the back teeth. There is absolutely a group of patients who need this kind of fixed restoration — people whose gum and bone anatomy simply can't tolerate a removable denture, or people who have kept their own teeth into their 50s, 60s or 70s and would struggle badly adapting to a denture late in life. Giving that patient a fixed alternative is one of the most rewarding things Dr. Reshad does. But it only works long-term if the implant distribution underneath it is right.

The other number that matters is the anterior-posterior (A-P) spread: draw a line through your two most distal implants, then measure the perpendicular distance forward to your most anterior implant. On average that's about a centimeter. The longer that spread, the further a cantilever can safely extend past it — this is the traditional teaching from the original Brånemark protocol, developed roughly fifty years ago and still the foundation of this math today.

Dr. Reshad has spent years repairing restorations built on a nearly straight line of implants with long cantilevers hanging off the back. One patient's case stands out: implants placed elsewhere, essentially no A-P spread, large bilateral cantilevers — and a restoration that kept coming loose, breaking abutments and shearing screws every few months. A single additional, well-placed posterior implant would very likely have prevented the whole pattern. He has built up what amounts to a library of these cases over the years: patients showing up late on a Friday afternoon or first thing Monday morning with a screw sheared off inside the implant, while he sweats over getting the broken piece out so they at least have teeth for the weekend.

There's also an asymmetry worth knowing about: in the upper jaw, when things go wrong under cantilever load, it's usually the implants that fail. In the lower jaw, it's usually the restoration that fails first. That means the upper jaw generally needs even more conservative planning around cantilever length and implant distribution than the lower jaw does.

With a cantilever in place, that 10-year failure curve arrives much sooner — often within five years. Dr. Reshad has personally replaced screws, abutments and fractured frameworks in patients who showed up, without fail, late on a Friday afternoon or first thing Monday morning.

Even a prosthesis made by a skilled lab, in gold or titanium, with proper support and design, will eventually fail if it's fighting a cantilever every time the patient bites down. Dr. Reshad has seen a whole library of beautifully fabricated restorations fail this way — not from poor workmanship, but from load magnification the cantilever created from day one.

There are better answers than a cantilever, and choosing the right one for your jaw is most of the art. Angling the back implants, using shorter ones, placing them where a routine plan wouldn't look — done well, these let the teeth reach further back with nothing left hanging unsupported. Dr. Reshad also checks the fit of every framework on a rigid test jig before it is ever finished, because a restoration that doesn't seat perfectly at the very back implant quietly behaves like a cantilever even when it was never designed as one. He is currently remaking an entire upper arch, done elsewhere, for exactly that reason. Catching it on the bench is far cheaper than discovering it in your mouth.

This is also, honestly, the case for treatment by a specialist prosthodontist rather than a generalist doing occasional full-arch work: an inaccurate impression or scan doesn't announce itself. It shows up months or years later as the pattern above — a hidden cantilever, a chronically loosening screw, a framework that never quite seated right from day one. Verifying fit on the bench, before fabrication, is a habit built from having repaired enough of the alternative.

One more idea worth knowing: the shortened dental arch. Most patients function perfectly well with about ten teeth per arch rather than a full complement stretching to the last molar — most don't even notice. As we age, we simply need fewer teeth to chew comfortably, and a shorter, cantilever-free arch is very often the stronger long-term choice over a longer one that requires a cantilever to complete.

Most conversations about full-arch dentistry focus on the front of the mouth — how much room there is for teeth to look natural. That matters: a well-emerging restoration typically needs about 17 mm of anterior vertical restorative space for a patient with a normal (Class I) jaw relationship. For a patient whose lower jaw sits further back (a Class II relationship) and who needs an all-on-4 style restoration, Dr. Reshad plans for even more — often 19–20 mm — because without it, you end up with an uncleansable "red" zone under the prosthesis instead of a gentle, hygienic "green" one. That has to be decided early, long before surgery.

But the space that actually determines long-term survival is in the back of the mouth, where sinuses, jaw anatomy and biting force all compete for the same few millimeters. Muscle force at the second molar runs around 200 newtons — roughly four times what the front teeth absorb. Combine very little height for the back teeth, a sinus that has expanded down into the bone, and a cantilever acting as an unsupported lever, and you have a near-guarantee of eventual implant loss or prosthetic fracture. Dr. Reshad has measured case after failed case where that posterior restorative space came in under 15 mm.

Dr. Reshad's answer for tight space at the back of the mouth is to build the restoration around a titanium bar, with the teeth and gum-coloured ceramic bonded over it, and deliver it as one piece that screws onto your implants. It stays strong even where it has to be thin, which is exactly the problem limited space creates. Getting there takes a specific sequence of planning, guided surgery and a trial restoration before the final one — each step is there to protect the one after it.

One case Dr. Reshad still thinks about had only 9 mm of posterior vertical restorative space, despite close to 17–20 mm anteriorly. Don't be deceived by generous space at the front of the mouth — he has planned cases with nearly 20 mm of anterior room and single-digit millimeters posteriorly, and the posterior number is always the one that decides whether the back of the restoration survives.

By Dr. Reshad's own standard, a restoration with 95% survival at five years counts as a genuine success. This design holds up well even at the ten-year mark, which is exactly why he defaults to it whenever posterior space is the limiting factor.

This is the geometry behind the "load & cantilevers" principle, isolated on its own: how far the implants are spread from front to back determines how much leverage a cantilever can generate against them. A wider spread means dramatically less force reaching the implants and the framework for the exact same bite.

The back of the jaw is where most implant plans give up. There's a nerve to avoid in the lower jaw, a sinus in the upper, and often less bone than anyone would like — so the standard answer is to stop short and let the bridge hang out over the gap. Dr. Reshad doesn't accept that as the default. Over thirty years he has built up a range of advanced techniques for getting reliable support into exactly those areas most plans avoid: different implant lengths and angles, different ways of using the bone that is there, and a planning process that finds the option a routine scan would miss. Which of them applies to you depends entirely on your anatomy — and that is a conversation for the consultation, with your scan on the screen in front of you.

What can be said here is why it matters. In Dr. Reshad's experience, getting support into the back of the arch instead of leaving it to hang can add a decade to the life of a restoration. It's a simple trade: a little more care in planning now, for a dramatically lower chance of a broken bridge ten years from now.

There's a second benefit that has nothing to do with strength. When the implant positions are planned this carefully, Dr. Reshad can usually give you a set of teeth on the same day as your surgery — a milled trial restoration, made in advance, that you can smile and speak with straight away. You leave with teeth, you get used to the shape and the bite before the final version is made, and the whole treatment takes far less time in the chair. It's one of the most underrated advantages of doing the planning properly from the start.

How your front teeth touch when you bite determines how much force reaches your back teeth — and therefore, once again, how much force reaches the implants holding everything together. Anterior guidance has to be shallow, and getting that wrong quietly overloads every implant behind it.

Patients who need full-arch reconstruction almost always arrive with a collapsed bite — years of wear have closed the height of their bite (the "vertical dimension"), sometimes into what Dr. Reshad thinks of as a "straight jacket": the upper and lower teeth locked together with no easy way to slide past each other. Part of the treatment is reopening that dimension deliberately, to a specific target: about 1 mm of vertical and horizontal overlap on the front teeth, a shallow angle of escape, and no more than 3 mm of the lower front teeth visible with your lips at rest.

This last principle is borrowed from classical denture prosthodontics — first described by Dr. Wilfred Fish in the 1930s, and refined by prosthodontists since — and it's the one most overlooked in fixed implant dentistry today. The neutral zone is the narrow space in your mouth where the outward push of your tongue is exactly balanced by the inward pressure of your lips and cheeks.

In a denture, building outside that zone just means the denture comes loose — annoying, but self-correcting, because the denture simply won't seat. In a fixed full-arch restoration, the teeth can't move. So building outside the neutral zone means the restoration is permanently pushing against your lips and cheeks, hour after hour, for the rest of its life, with nowhere for that pressure to go.

Anatomically, this makes complete sense once you look at it: the corner of the mouth has no bony support at all. It's held together entirely by soft tissue and muscle — a knot of muscle at the corner of the mouth called the modiolus, and everything attached to it — which makes it, by a wide margin, the weakest and most easily irritated part of the entire system. It's also, unsurprisingly, exactly where these patients complain the most, and exactly the area conventional implant planning thinks about the least.

Case 02 · Referred for revision — outside the neutral zone

This patient came to Dr. Reshad after a full-arch restoration elsewhere left him unable to close his mouth comfortably. His chief complaint was simple and constant: the restoration hurt his lips. He couldn't chew properly, and he couldn't fully close his lips around the prosthesis whether it was in or out of his mouth. His restoration was built far too thick from cheek-side to tongue-side, constantly pressing against his lips and cheeks. He was in daily discomfort from a problem that had nothing to do with the implants themselves and everything to do with where the teeth had been positioned relative to his own soft tissue.

The fix uses a technique with a very simple premise: a soft, room-temperature wax called Adaptol is built onto the anterior portion of the framework as a bite block, placed in the patient's mouth, and the patient is asked to talk, sip a cup of coffee, and move naturally. Their own lips and tongue sculpt the wax into exactly the shape and position their neutral zone allows — and that's precisely where the teeth are then set.

The original restoration (above) compared to the redesigned result from two angles, moved substantially inward — a visibly slimmer design, set further in toward the tongue — to sit within his neutral zone. He can now close his lips fully, speak clearly, and eat without the constant pressure that brought him to Dr. Reshad in the first place.

One detail from that case is worth mentioning honestly: in his lower jaw, Dr. Reshad had no control over how high up his existing implants had been placed by the original surgeon — a real compromise he had to plan around rather than starting from a blank slate. A screw-access hole would have come out through the biting edge of one front tooth as a result, which he corrected with an angled connector that redirects the screw channel out of sight. The case was still salvaged by properly applying the neutral zone concept, even working with implants he wouldn't have positioned that way himself — which tells you how much of the outcome the neutral zone decision controls, even when other parts of the case aren't ideal.

A first reconstruction is planned. A revision inherits whatever the first one left behind, and has to produce an excellent result from a compromised starting point.

Knowing how to build a framework that corrects for positions you did not choose, and then make teeth on top of it that nobody can read as a correction, is a specific body of knowledge. This one is in the literature.