This patient’s main issues were that he was unable to eat and did not like to smile. His issues were to do with a dysfunctional severe malocclusion due to a genetic discrepancy in the size and alignment of the jaws crowding of the teeth and a deep bite.
One of the options considered was orthognathic jaw surgery and orthodontic treatment (braces) however due to numerous missing teeth as well as other deteriorated teeth this option had limited prospects of success with more significant risks.
Treatment using All On 4 Plus in the upper and All On 4 in the lower meant a ‘new canvas’ with improved artistic and technical freedom to design the new teeth to a more ideal bite and aesthetic balance.
1. The laboratory has created a wax-up to demonstrate to our implant surgeon the required changes. Due to the extremity of the changes half of the stone models of each arch were cut back and teeth were set in red wax retaining a reference to the old set.
2. RIGHT side view before treatment. This picture illustrates the severity of the malocclusion.
3. RIGHT side the very next day after surgery.
4. LEFT side view before treatment.
5. LEFT side the very next day after surgery.
6. FRONT BITE view before treatment. Note the complete overbite and how the lower teeth bite behind the upper teeth. In fact","the lower teeth were biting into the gums behind the front uppers causing this patient a great deal of discomfort.
7. FRONT BITE view the very next day after surgery. The functional bite improved.
8. FRONT RELAXED view before treatment. Note the wavy and uneven plane of the upper and lower arches with supra-eruption of various teeth.
9. FRONT RELAXED view the very next day after surgery. The plane of occlusion restored.
10. UPPER OCCLUSAL view before treatment. Note the V-shaped arch-form.
11. UPPER OCCLUSAL view the very next day after surgery. A more comfortable and rounded arch-form. Being the day after surgery there are bruises visible in the palate. These could take about 7 days to resolve. Also of note is the positioning of the front implants tightly behind the lateral incisors. This ensures that the prosthesis is thin and comfortable.
12. LOWER OCCLUSAL view before treatment.
13. LOWER OCCLUSAL view the very next day after surgery.
14. 12 months after upper All On 4 Plus and Lower All On 4 treatments.
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