Designer Smiles
Dental facelift: Rehabilitation of Terminal Dentition Complete denture opposing on All On-5 Case Study

Rehabilitation of Terminal Dentition

  • Terminal mandibular dentition affecting speech function and comfort worsening since 2005
  • Reason for past tooth loss: caries, periodontal disease as a result of poor oral hygiene years ago
  • Maxillary (upper) denture constructed 10 years ago
  • Negative adaptation history to maxillary denture
  • Inability to speak clearly and with confidence: well the denture is loose!

Chief concerns:

  • My lower teeth are mobile, I only use my top plate for eating and its usually in my shirt pocket for last 12 years, its bulky”
  • “Want to eat again and smile with confidence”
  • “ I want a fixed denture for my bottom jaw, since I can tolerate the top loose plate”
  • Prosthesis stability: comfort
  • Aesthetically pleasing complete RDP
  • “Want to improve my health”

This study will show;

  • Complexity of treatment. Hence specialist intervention is required as precise outcome is critical in this complex smile outline
  • Treatment outcome
  • Patient’s assessment
  • Please refer to the video provided.
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Initial Presentation

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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).


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.

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Final treatment outcome: we have restored aesthetics comfort & function and we have a happy patient.
Final treatment outcome: we have restored aesthetics comfort & function.
However most importantly we have complemented our lovely patient’s facial aesthetics.

Dr. Sarkis Nalbandian

Registered 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)