The FPX Methodology

In many conventional FP1 workflows, implant depth is set in relation to the existing bone crest, often about 1–2 mm subcrestal. The implant position is not planned from the intended gingival zenith and the final prosthetic tissue architecture.

Multi-unit abutment height is often chosen for convenience and restorative access, not as part of a strategy to preserve supracrestal tissue dimensions.

The initial result can be excellent. It can also leave less vertical space for the peri-implant soft tissue, and less restorative flexibility if crestal bone levels change.

FPX applies current evidence on subcrestal implant positioning, platform switching, conical implant-abutment connections, abutment height, and supracrestal tissue height.

Randomized clinical studies show that platform-switched implants with conical connections can maintain favorable marginal bone levels when placed subcrestally. In a multicenter randomized trial comparing implants placed 1 mm and 2 mm subcrestally, overall marginal bone remodeling was similar. None of the implants placed 2 mm subcrestally had bone levels apical to the implant platform after one year of loading. Other randomized trials report stable peri-implant bone around subcrestal platform-switched implants and, in some studies, less marginal bone loss than with crestal placement.

Abutment height matters too. In a randomized trial, 1 mm abutments showed significantly greater marginal bone remodeling than 3 mm abutments with the same implant design and platform switching.

So does the vertical soft-tissue dimension. Recent randomized evidence associates insufficient supracrestal tissue height with greater marginal bone-level changes. The restorative components should not take up the whole vertical soft-tissue compartment.

Rigid cross-arch splinting shields bone from load. The FPX view is that bone protected this way is under-stimulated over the long term.

A conventional definitive restoration is one rigid framework across the whole arch. Long full-arch frameworks need substantial rigidity and must fit accurately on implants spread across the entire arch.

A 2026 clinical study followed 14 patients with segmented mandibular full-arch prostheses supported by at least six implants. Across 119 implants and an average follow-up of about three years, implant survival and prosthetic survival were both 100%, and no biomechanical complications were reported. The authors concluded that segmented implant-supported full-arch prostheses are a viable alternative to one-piece mandibular restorations.

Traditional full-arch bone reduction often creates a relatively flat alveolar platform. That simplifies implant placement and provides restorative space, but it can sacrifice bone that would support soft tissue and natural gingival architecture.

Contemporary FP1 protocols have started to challenge this with mesial-distal scalloped reduction based on the planned gingival margins. Published techniques show that scalloped reduction can limit unnecessary bone removal and better reproduce the soft-tissue architecture of a pink-free FP1 restoration.

Alveolar contour helps determine prosthetic space, esthetics, and peri-implant soft-tissue morphology in full-arch implant therapy. Current literature increasingly favors prosthetically planned, selective alveoloplasty over routine flat reduction.

Mesial-distal scalloping lets the bone follow the planned gingival form. FPX also controls the buccal-lingual contour, which gives the peri-implant tissues a three-dimensional foundation.

In many full-arch workflows, soft tissue is managed mainly to achieve closure around the provisional restoration. If the prosthesis is seated and the tissue heals around it, the soft-tissue phase may be considered complete.

Closure does not mean the peri-implant tissues have the width, thickness, stability, or vertical dimensions needed for long-term maintenance.

A band of about 2 mm or more of keratinized mucosa has been associated with better plaque control, less brushing discomfort, less mucosal recession, lower marginal bone loss, and a lower incidence of peri-implantitis than sites with inadequate keratinized tissue. This means a true apico-coronal band extending away from the peri-implant margin, not tissue compressed or sutured beneath the prosthesis.

Thicker peri-implant mucosa has been associated with greater soft-tissue stability and less recession. Adequate supracrestal tissue height provides the biologic space needed between the crestal bone and the restorative complex.