When designing full-arch implant cases, we often assume all teeth must be removed all together. However, the sequence of those extractions—what I call a strategic extraction—can simplify your surgical guide design and the surgery.
When it comes to surgical guide designs, tooth-supported guides are usually the most easy and stable. But in full-arch cases, the teeth are usually planned for extraction. This makes guide stability questionable because the most solid landmarks and supporting areas are gone.
Is it possible to maintain tooth-support even for full-arch patients? Yeah!
If the clinical condition allows, we can utilize a strategic extraction:
Keep 3 to 4 anchor spots across the arch (for example, the canines and second molars in this case).
Use these remaining teeth for solid cross-arch stabilization during the guided surgery. And extract these final "anchor teeth" only after the implants are placed.
In the case shown here, although the other teeth were digitally extracted for guided sleeve clearance, the remaining canines and molars provided a rock-solid supporting area. This makes both the guide design and the surgery much more predictable.
Combining this strategic teeth extraction with DAS guided sleeves, simplifies the entire digital design and surgical execution.