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Complex Prosthetics and Dental Rehabilitation

Complex Prosthetics and Dental Rehabilitation - Patient Story

Dental facelift: Rehabilitation of partially edentulous maxilla and mandible case study. The patient presented with a family history of osteoporosis. In 2001, diagnosed and treated with bisphosphonates. Unfortunately for this healthy patient following treatment with Fosamax, bisphosphonate related osteonecrosis and severe intractable oro-facial pain required removal of teeth and segmental mandibular osteotomy: 46 – 32 by oral and maxillofacial surgeon. Implant replacement is not an option since risk of osteonecrosis is very high. The oral and maxillofacial surgeon did lifesaving, wonderful work for this most lovely and gracious patient, who has been through so much pain, discomfort and misery as a result of MRONJ


Chief concerns

  • “I want to smile and chew better”
  • Improve confidence
  • Pain on lower chin from pressure
  • See the history below
  • Removable prosthetic solution as implants are contraindicated
  • Cost is always a concern

This study will show

  • Complexity of treatment
  • Treatment outcome
  • Patient’s assessment
  • Please refer to the video provided

Initial Presentation

Reduced lower right lip and cheek support due to missing 46 – 32: affecting comfort, function symmetry and aesthetics

Diagnosis: With a history of MRONJ and segmental mandibular osteotomy, patient is dissatisfied with reduced masticatory efficiency causing: phonetic, functional and aesthetic disturbance

Our Aim: to improve; phonetics, comfort, function and aesthetics the aesthetics to provide, most importantly, confidence for this delightful patient.

This was accomplished with minimal discomfort to the patient and she never left the practice with missing teeth. The provisional teeth for optimal aesthetics and function.


Following with discussion of all risks and treatment modalities with our patient that included

  1. No treatment: this is not an option
  2. Fixed option is contraindicated as we have a history of MRONJ (medication induced osteonecrosis) – accepted by the patient

Procedure & Results


Lower arch: The lower precision fitted partial denture simply disappears in the mouth: restoring missing hard, soft and dental (teeth) tissues.

Clinical: Reconstruction of upper arch: replacing existing crowns and bridgework and providing special milled crowns to provide special support and stability for lower precision fitting Chrome -cobalt partial prosthesis (denture).

Laboratory: Reconstruction of upper arch: Tooth supported crowns replacing existing crowns and bridgework.

Final treatment outcome

we have restored aesthetics comfort & function.

However most importantly we have complemented our lovely patient’s facial aesthetics.

Note improvement in lip symmetry, thickness & support in combination of correcting protruding maxillary central incisors

Final treatment outcome: we have restored esthetics comfort & function and we have a happy patient with confidence.


Hence I use the term: dentofacial rejuvenation

Thank you for taking the time to explore this patient’s story. I hope this gives you an idea of what I can do for you if you are having difficulty and need help, because there is always hope.

Dr. Sarkis Nalbandian
Visiting Professor YSMU
Specialist Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth) FIADE, FPFA