Designer Smiles
Dental facelift: Rehabilitation of Partially Edentulous Maxilla & Mandible

Case Study

  • W. presented with 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 & Maxillofacial surgeon.
  • Implant replacement is NOTan option since risk of osteonecrosis is very high.
  • The Oral & Maxillofacial surgeon did a 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.
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Chief concerns:
“I want to smile and chew better”Improved 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
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Initial Presentation

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


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

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

This was accomplished with minimal discomfort to the patient and Mrs. W. Never left the practice without missing teeth. The provisional for optimal aesthetics and function (please Videos provided).



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.

Initial Presentation

Lower arch:

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.

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


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 the term: dentofacial rejuvenation by Dr Sarkis Nalbandian

Final treatment outcome and we have a confident and happy patient.

Dr. Sarkis Nalbandian 

Registered Specialist   

Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Pros) King’s College, Uni London

  1. Clin. Dent (Pros) Uni Syd, FRACDS, MRACD (Pros)