Upper All-On-4 Plus & Lower All-On-4 for 50 YO Architect

This patient has lost numerous back teeth over time and was finding it difficult to chew. He was also conscious of the gappy appearance and didn\u2019t like his smile. He had gum disease which resulted in the splaying and looseness of his teeth. The patient had an adequate quantity of bone for All On 4 but the quality of the bone was poor.

As such we raised the possibility that due to the poor quality bone in the upper jaw we could not be certain that four fixtures would be enough to support full set teeth replacement in the long term.

However, as there was not enough bone in the back of the upper jaw for any such additional fixtures in the future we recommended considering OPTIONAL bone grafting done simultaneously with All On 4 treatment so as to build up the bone reserves for improved contingency. We would then monitor his progress over time before we determine whether additional implants are required. The healing of the implants was unremarkable and as it turned out after 3 years in the function we were able to ascertain that the four original implants were indeed enough for long-term support.

However, this patient developed a heavy bite and there was a problem with the improved biting pressures which were beyond the tolerance of the acrylic prosthesis, and a crack developed over time The long term treatment was completed without additional implants only with upgrading his upper and lower teeth to the much more durable Zirconia bridge.