Full-Arch Immediate Maxillary Rehabilitation Using Intraoral Welding and Immediate Loading

Clinical Protocol

The case used intraoral welding with immediate implant loading for maxillary full-arch rehabilitation. The treatment objective was to restore function, aesthetics, and patient comfort in a single clinical workflow while controlling micromovement during early healing.

Patient Profile and Diagnostic Assessment

• Patient Demographics58-year-old female, systemically healthy, non-smoker.
• Chief ComplaintProgressive tooth mobility, multiple missing maxillary teeth, chronic masticatory inefficiency, and poor smile aesthetics.
• Clinical DiagnosisGeneralized Stage IV, Grade C periodontitis with secondary occlusal breakdown, pathological tooth migration, and localized severe alveolar ridge resorption.
• Mandibular ArchStable, maintainable natural dentition following non-surgical periodontal therapy and occlusal plane equilibration.

Comprehensive clinical and radiographic examination revealed terminal dentition in the maxillary arch, extensive bone loss, clinical attachment loss, generalized Grade II-III mobility, pathologically migrated anterior teeth, and edentulous spans. The lower arch remained stable and maintainable after periodontal debridement.

Surgical Protocol: Extraction and 6-Implant Placement

The strategic polygonal distribution of six implants maximized the anteroposterior spread, reducing cantilever stresses and creating a rigid arch perimeter suitable for immediate same-day cross-arch splinting.

1. Surgical debridement and platform preparation: Atraumatic total maxillary clearance was performed under local infiltration anesthesia using periotomes to preserve residual buccal bone plates. Sockets were degranulated, followed by minor alveoloplasty to create a flat prosthetic resting platform.
2. Strategic multi-implant installation: Six endosseous implants were distributed across the maxilla in bilateral anterior, premolar, and molar regions, engaging residual dense basal bone to establish wide anterior-posterior spread.
3. Primary stability verification: High primary stability of more than 35 Ncm insertion torque was achieved across fixtures, satisfying prerequisite criteria for immediate functional loading.
4. Multi-unit abutment connection: Multi-unit intermediate abutments of appropriate angulation and cuff height were torqued onto the fixtures to reconcile divergent implant insertion paths into a common path of insertion.

Intraoral Welding and Framework Splinting

To limit harmful micromovements during early bone healing, an intraoral electric resistance welding protocol was executed chairside directly in the oral cavity.

1. Titanium bar adaptation: Dedicated titanium welding copings were secured onto the multi-unit abutments. A Grade 2 commercially pure titanium bar was passively contoured along the lingual and palatal arch curvature.
2. Electrical syncrystallization welding: Electrical resistance welding pulses were delivered through copper electrodes under continuous mechanical compression, fusing the titanium bar directly to the abutment sleeves.
3. Bench inspection and passivity confirmation: The rigidly welded framework was unscrewed and evaluated on the bench, verifying passive fit without internal tensile or rotational stress.
4. Framework reinforcement and opaquing: Additional retentive spurs were spot-welded to provide mechanical retention for acrylic teeth. The framework was sandblasted, treated with metal primer, and coated with opaque pink masking resin.

Prosthetic Conversion and Immediate Delivery

1. Prosthetic hollowing: The pre-fabricated immediate acrylic denture was hollowed lingually and palatally to seat passively over the splinted framework without soft tissue interference.
2. Chairside intraoral pick-up: Intraoral pick-up was performed using auto-polymerizing resin in verified centric relation at the correct vertical dimension of occlusion.
3. Prosthetic finishing and hygiene contouring: The prosthesis was unscrewed, palatal coverage was eliminated into an open-palate design, and excess acrylic was trimmed to create smooth, cleansable contours.
4. Prosthetic delivery and occlusal equilibration: The screw-retained provisional prosthesis was torqued into position, screw access channels were sealed with PTFE and composite, and balanced group-function occlusion was verified.

Clinical Significance and Biomechanical Conclusions

The intraoral welding technique enables immediate rigid cross-arch splinting chairside, bypassing impression inaccuracies, extended laboratory turnaround, and removable temporary prostheses. By reducing interfacial micromovement, it creates favorable biomechanical conditions for undisturbed osseointegration while delivering immediate functional chewing and aesthetic restoration in a single clinical appointment.