Patient was referred by his dentist, seeking a dental 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.
Note Upper arch: edentulous and lower arch with broken-down dentition, and crowns.
Diagnosis: Unacceptable dental aesthetics & function due 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 construction 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 implant and fixed bridgework. However, those few patients who cannot adapt to new upper denture that has been tried by myself, then the next option is to consider upper (maxillary) fixed implant supported bridgework.
This was accomplished with minimal discomfort to the patient and he left the practice without teeth. The new maxillary denture and lower provisional bridgework as both aesthetic and function.
Following with discussion of all risks and treatment modalities with our patient that included
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.
Lower arch: 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.
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.
Final treatment outcome and we have a confident and happy patient.
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