Initial Presentation

Patient was referred by her dentist, seeking specialist’s opinion and treatment in relation to fixed option of restoring missing teeth and failing dentition. Patient being a past model had difficulty in adapting to his current upper denture/plate. He also retained his lower teeth due to fear in wearing a complete lower denture, since the upper denture was unsuccessful.

Most of the time upper plate was in the patient’s top shirt pocket, only using to chew his food.: affecting his confidence in his profession.

We have unacceptable aesthetics and function. It’s surprising to see how much patients can tolerate with broken down dentition. I guess we all are busy in our lives, looking after the family and finally when everyone is ok, it time for us.

Diagnosis: Unacceptable dental aesthetics & function due to dissatisfaction with failing: teeth, fixed restorations and poor adaption to existing upper inadequate denture.

Our Aim: to improve the aesthetics of upper arch: New denture correctly constructed for patient comfort speech. Followed by constructed of implant supported fixed lower bridgework.

In patients with maladaptation to upper dentures, we normally construct a well-fitting and aesthetic denture. If this is satisfactory, there is no need for further treatment with the implant and fixed bridgework. However, those few patients who cannot adapt to a new upper denture that has been tried by Dr Nalbandian, then the next option is to consider upper (maxillary) fixed implant-supported bridgework.

This was accomplished with minimal discomfort to the patient and Mr M. Never left the practice without missing teeth. The new maxillary denture and lower provisional bridgework as both aesthetic and function (please Videos provided).

Treatment

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

1. No treatment: this is not an option as the restorations are failing and affecting longevity of supporting teeth
2. Fixed option: implant supported upper and lower fixed bridgework-assuming there is intolerance to upper denture
3. Provision of new upper denture as the patient can adapt and construct new lower implant supported fixed mandibular(lower arch) bridgework) and accepted by the patient

Procedure & Results

Construction of aesthetic and well-fitting maxillary complete denture, followed by Immediate provisional (ISFDP) Implant-supported fixed bridgework as the lower teeth are removed and the provisional bridge constructed within few hours on the day of the implant placement.

Laboratory: Reconstruction of upper arch: complete maxillary prosthesis

Clinical: Reconstruction of upper arch: implant-supported bridgework and tooth-supported crowns.
The work was completed in six months and implants to integrate with bone. Is best not to rush biology and allow optimal healing.