Full-arch implants: what 29 Italian experts agreed on — and what it changes in practice

How many implants for a full-arch? Tilted or axial? Which prosthetic material, and what maintenance keeps peri-implantitis away? On these everyday questions practice is still heterogeneous. To bring order, an Italian Consensus Conference convened 29 experts and ran a modified Delphi process, supported by a systematic review of the 2015-2024 literature with certainty of evidence graded through GRADE. Consensus was set at a demanding threshold of 90% agreement.

Seven statements emerged. First, periodontal risk should be assessed with validated tools before treatment is planned. Second, guided bone regeneration (GBR) outcomes are technique-dependent, and indications must be matched to the technique. Third, in the mandibular full-arch, four implants can support rehabilitation with survival comparable to six. Fourth, tilted and axial implant configurations are clinically equivalent. Fifth, on prosthetic materials, monolithic zirconia shows high survival. Sixth, risk-stratified supportive maintenance is associated with lower peri-implantitis incidence. Seventh, systemic risk must be stratified, covering absolute and relative contraindications, MRONJ risk management, and perioperative antibiotic prophylaxis.

The value of the document is less in novelty than in arbitration: it converts scattered evidence into shared, graded recommendations a clinician can defend. For implantologists and prosthodontists it offers a structured reference for patient selection, surgical layout, material choice, and the maintenance protocol that ultimately decides whether a full-arch lasts.