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Which patients are ideal candidates, and which cases should I avoid?

Careful case selection is essential. Most full-arch cases cannot be treated with an FP1. Limiting factors include hygiene access, the extent of bony defects, and the need to reset the bony architecture. The criteria below come directly from the FP1 Handbook.

Ideal candidate criteria:

Parameter Specification
Age Roughly 25 to 60
Bone and tissues May have dental disease (decay, failing crown and bridge) with teeth at terminal prognosis, but typically with healthy bone and soft tissue architecture intact
High lip line Not necessarily disqualifying, but the esthetic zone demands natural tissue display, symmetry, and high performance across planning, surgery, and restoration
Hygiene Acceptable hygiene is important for long-term success
Bone modification Less is better. Excessive reduction and trauma lead to poor results
Bone symmetry Good symmetry is ideal for planning a balanced smile

Contraindications and cases to approach with caution:

Contraindication Clinical concern
Periodontal disease Infrabony defects, unpredictable healing, compromised soft tissue, and inflammation reduce predictability. Risk rises sharply with an active smoker.
Significant bony defects Vertical or lateral defects produce long clinical crowns and extended contact points, worse with a thin soft tissue biotype.
Extensive gingival recession Gumline symmetry can be compromised.
High esthetic demand Proceed with caution. If expectations exceed achievable FP1 outcomes, FP3 may give superior esthetic control.
High lip line plus angled posterior implants If straight implants are only achievable canine-to-canine and the patient needs angled posterior MUAs, FP1 is not recommended. Consider a staged approach or FP3.

The Handbook also frames a practitioner skill self-assessment: the ability to perform soft tissue grafting (CTG/FGG), manage multi-site bone grafts in a single surgery, understand FP1 restorative design principles, execute the suturing and flap skills needed for ideal papillae, and perform partial extraction therapy (PET) where indicated.

Plan for failure on every case: document the next treatment option if the restoration fails, set implant depth to allow a future FP3 (which requires bone reduction to the top of an implant), confirm the patient has sufficient biological capital for future interventions, and ensure thorough informed consent for higher-risk patients.

 

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