Before
After
Case Details
The Case
- 74 Years Old Retiree
The Problems
- Full upper denture getting progressively looser and held in place with denture adhesive
- Lower denture is intolerable and not worn at all Severe atrophy and minimal residual jawbone remaining Unable to chew and function
- Severe atrophy and minimal residual jawbone remaining Unable to chew and function
- Unable to chew and function
The Solution
- Lower All on 4
- Timeframe: 2 Days
- Upper Grafting and 2-Stage Fixed Bridge on Six Dental Implants
- Graft Healing Period: 12 months
- Timeframe following healing of the grafts: 3 Days
- Original Treatment Early 2008
Doctors Comments
This lady presented with extremely loose dentures. Her dentures became progressively looser over time because the gums were shrinking as a result of natural atrophy of the bone. As the jawbone and gums atrophied, the nerves that usually lye inside became exposed and the lower denture was pressing on these nerves giving this lady a great deal of discomfort. It became intolerable to the point that she was unable to wear the lower denture in her mouth. She kept it in her pocket. She was unable to eat most foods and even though the appearance of her dentures was not ideal, this was the least of her concerns. All she wanted was to be able to eat and function better.
In the lower jaw as it turned out there was marginally sufficient bone for standard and immediate fixed teeth replacement with All On 4 dental implants procedure.
In the upper jaw due to the severe atrophy, there was not enough bone to do the same. There were two options. The first option was to avoid the poor areas of the jawbone and rely on the cheekbones for support using Zygomaticus implants. This would have given this patient an immediate fixed bridge. The second option was to undertake bone grafting to reconstruct the volume of available bone. The downside with the second option was the need to wait for a period of 12 months before the grafts are sufficiently consolidated to accept dental implants.
For this patient, the main problem was the lower denture, whereas she was still coping somewhat with the upper. For her having worn an upper denture for so long, there was no issue in waiting another 12 months before getting dental implants in the upper. She opted for the grafting option.
The lower All On 4 and the Upper bone grafting were both performed in one session. The lower fixed replacement teeth were fitted within 2 days and the patient continued to wear her upper denture while the grafts were consolidating. After 12 months, we placed six fixtures in the upper grafted bone and provided this lady with immediate fixed replacement teeth.
In 2013 one of the very back implants in the upper had failed. She was not aware of it we discovered this in our routine reviews. Due to the fact that we performed bone grafting in the past, there was enough bone to replace the failed implant and immediately rectify the situation.
She continues to enjoy her fixed implant bridges today.
The Process
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.
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.
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.
