53 year old, Female

   
Patient: 53 year old, Female
Concerns:
  • Loose and drifted teeth – affecting cosmetic smile appearance, eating and chewing.
  • Seeking opinion on “All-on-4” implant procedure for the replacement of all her teeth.
Diagnosis:
  • Severe periodontal (gum and bone) disease with signs of occlusal trauma (positional changes and tooth movement with biting).
  • Multiple missing back teeth – severe shortened dental arch – inadequate number of teeth for satisfactory masticatory (eating and chewing) function.
  • High smile lip line with full display of gum above upper front teeth.
Management:
  • Atraumatic extractions (removal) of all teeth, bone augmentation and surgical implant placements by a specialist periodontist.
  • Construction of temporary upper and lower full arch implant supported acrylic bridges – to replace teeth within 1 week after tooth removal.
  • Following gum and bone healing period
    • Construction of final upper full arch implant supported ceramo-metal (porcelain fused to metal) bridge – “tooth coloured crowns” emerging from the gum to achieve natural and aesthetically / cosmetically pleasing result.
    • Construction of final lower full arch implant supported metal-acrylic (hybrid) bridge – with “metal-acrylic margin” hidden by lower lip – providing a more affordable option given lower aesthetic / cosmetic demand (as compared to upper counterpart) with no display during talking and smiling.
  • Note: This case is not suitable to have “All-on-4” implant procedure for the upper jaw. Unless excessive bone is removed from the upper jaw, it is impossible to create a natural and cosmetically / aesthetically pleasing smile and hide the “metal-acrylic margin” under the upper lip in a patient with high smile lip line.