This article describes a staged approach to provide a fixed restoration to patients with a hopeless dentition without a removable provisional phase. The rehabilitation protocol, which includes initial conservative periodontal care, starts with strategic extraction of some of the remaining teeth. The aim of the first step is to permit implant placement and to strategically keep residual teeth as abutments for a provisional fixed denture during the implant healing period. After the implants have osseointegrated, abutment connection is performed, residual teeth are extracted and, simultaneously, a second group of implants is placed. A second fixed provisional restoration is delivered to the patient. After the second group of implants has healed, the patient is ready to undergo normal prosthetic treatment. Advantages of the technique include no removable provisional prosthesis, soft tissue management, preserved function and enhanced esthetics during treatment, and prosthetically driven implant placement. The main drawbacks are extended treatment time, adjustments of the provisional restorations, and no less than two surgical steps.
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