Implant supported denture while implant integrates?

In many instances second molars are not replaced with implants. In all on 4 almost never the hybrid bridges go beyond first molar. Therefore the replacement of #2 is no issue unless the patient insists. #3 and #13 will be replaced with implants. That leaves #7. An interim valplast partial will provide the function and esthetic consideration. Upon integration of #3 and #13 a fixed bridge could solve the problem of #7 or a single tooth partial.

The case is difficult to visualize without an image. We don't know which teeth are present and which will remain after extractions. My questions are: How functional is the partial currently (could the patient continue to wear it)? How urgent are the extractions? Is it practical to place implants in locations other than planned extraction sites? A treatment sequence that is sometimes possible is to place implants as stage one treatment. Allow them to osseointegrate prior to extraction so that the implants can be loaded immediately after extraction. Here is a purely hypothetical case to demonstrate a treatment sequence. First we treat necrotic teeth with antibiotics and pulpal debridements to eliminate acute pain. This stabilizes the patient who continues to function with the existing removable partial. Second we place implants. These may be placed in locations where teeth have already been extracted. Or we will extract single teeth and replace them with implants either immediately or after grafting. If extracting, we will add a tooth to the existing partial chair-side for esthetics. Fast forward to two weeks before extractions (3-8 months after preliminary extractions and implant placement), patient presents for abutment placement and impression for an interim immediate partial denture incorporating the attachment system. At the extraction appointment we remove teeth, confirm the attachment system engages, place a soft liner and deliver an implant retained provisional partial. Impressions for the final prosthesis come four months later.

We assume that the patient has only 2 teeth to be extracted, I would fabricate temporary immediate denture , while he's healing and the implants have integrated.then you can use locator and move on the next phase, if patient wants all on 4 then you can place multi unit abutments, and fasten the denture to the implants, I would suggest take hand on course to be more comfortable doing cases like this.