1. The dentures loosely fitted over the bare gums. The bite is not ideal because over time the bone has atrophied and this changed the positions of both dentures.
2. Under the dentures, in the lower, the jawbone was completely flat, but there was just enough for an All On 4 procedure. In the upper, there was some bony height, but it was extremely thin under the gums, like a knife edge.
3. We placed the lower implants using computer-guided surgery (Nobel-Guide).
4. We also adjusted the gums to ensure thicker and more ideal tissue surrounds the implants. We closed the wounds with dissolvable sutures and comfort caps were placed whilst the teeth were being fabricated over the next 24 hours.
5. An impression of the implants was taken and sent to the laboratory to make a model and fabricate the prosthesis.
6. The laboratory constructed lower replacement teeth using highly aesthetic high-impact acrylic.
7. The very next day, the lower fixed replacement teeth were permanently screwed to the implants.
8. In the upper jaw, the patient continued to wear her upper denture. This picture illustrates the complete healing of the gums at 6 months after an alveolectomy and bone grafting procedures were performed in the upper jaw at the same time as the lower All On 4 dental implants.
9. After complete consolidation of the grafts, six dental implants were placed using computer guided keyhole surgery. Comfort caps were placed during the fabrication process. Note: There are no stitches with this keyhole surgical method. ALL-ON-4-CLINIC Dental-Implants 2209
10. Within a few hours, our laboratory technicians have set teeth in wax, which we fitted to the implants as a try-in to assess function, aesthetics, comfort and speech. After all parameters were met, we sent it to production. ALL-ON-4-CLINIC Dental Implants 2211
11. The upper replacement teeth were fabricated using highly aesthetic high-impact acrylic.
12. The new fixed replacement teeth were fitted within 24 hours from the placement of the dental implants.
13. This was the patient before her treatment. The lower denture was in her pocket, and the upper denture was so loose that it dislodged when we asked her to smile for this picture. ALL-ON-4-CLINIC Dental Implants 2212
14. The patient with her fixed replacement teeth supported by dental implants in the upper and lower jaws.