This patient had advanced gum disease and his teeth became very loose. He noticed that the appearance of his teeth has changed. He always had bucky teeth when youger but they started to spread and splay with the gum disease leaving big gaps. Apart from not liking the way his teeth looked, he also had pain and lots of trouble eating. He dreaded the thought of having to go into dentures.
As a result of the gum disease, the patient’s upper jawbone has deteriorated substantially and it was not possible to treat him with the standard All-On-4 procedure. He needed simultaneous bone grafting and received All On 4 Plus dental implants in the upper jaw.
In the lower jaw he had a number of teeth that could have been saved. One option we considered with the patient was to treat the lowers by undertaking gum treatment and other restorative dental work and dental implants to replace missing teeth. However, as many teeth have moved, the plane of occlusion has been distorted and designing the uppers to match the existing lowers will have compromised the result in the upper. Also, if we had placed any implants in the lower jaw to replace missing teeth, when the remaining teeth are lost it would not have been possible to use those existing implants to support an All On 4 style bridge because the fixtures are inserted in quite a different way compared to when we do single implants. The patient decided against keeping some of his lower teeth and opted for All On 4 in order to achieve a more ideal occlusion (bite) and aesthetics.