Surgical Extractions · Immediate Implant PLACEMENT · All-on-4 Prosthesis

Aim

For this gentleman, he was aware of the increasing mobility of his remaining upper teeth and had recently fractured part of his dental bridge. Given the limited number of healthy teeth, the patient was aware that he would be needing to plan for the eventual loss of nearly all of his upper teeth.

Taking this into account his discomfort chewing with his existing partial denture, the patients' goal was to have treatment that would be long-lasting, non-removable and would restore his chewing function once again.

After discussing treatment options over multiple appointments, we settled on planning for the replacement of the entirety of his upper dentition with a fixed bridge, which would be supported by 4 implants (All-on-4). For his lower bridge, he had no concerns with the appearance and was happy to leave this well alone.

How did we achieve this?

As part of our procedure for ensuring patients are well informed and aware of the outcome of intended treatments, we performed a rough mock-up to help us gauge important aspects for the patient such as the future positioning of the teeth and gums. A prototype fixed bridge was prepared in advance using the information gathered, ready to be fitted at his surgery appointment.

Before

Attending with a loose fractured upper bridge, teeth of different colourations and missing back teeth.

Before (Right side)

Pulling the cheek aside reveals recession present on the foundations of the bridge as seen by their increased length. The crowns can be seen apart from the natural tooth from the colouration differences.

Missing back teeth and previous bone loss have resulted in the teeth becoming mobile and difficult to chew upon.

Taking measurements

From a side profile view, the gap where the teeth are missing is more apparent. Here we are taking measurements and proposing changes we will make.

Proposing the new Gum-line

In red, we have outlined how much of the gum we would like to see towards the end of treatment. This is a crucial part of our planning protocol, and allows our patient to confirm with us at an early stage that both patient and dentist are on the same page.

His lower bridge is functioning well, and has been made to try and match the opaqueness of the upper teeth. Given we will be performing treatment for the entire upper jaw, we have full artistic freedom to change this, for the upper teeth.

Proposed Gum Show on Smiling

The red wax is not particularly visible when the patient smiles currently. As we will be completely replacing a portion of the bone, teeth and gums- we need to get this part right!

3 Months After Surgery

Following the removal of the upper teeth, which coincided with the reshaping of the upper jaw bone and implant placements, the patient has healed well. After 2 months with his temporary bridge, we are ready to replace the missing teeth, gum & bone with a final bridge.

Definitive Bridge

The final bridge is made bespoke for each patient by highly skilled laboratory technicians. Here the height of the teeth when smiling, size and position, as well as gum heights, have been accurately produced.

The bridge will be anchored on to the four implants and so will not move at all during chewing.

Final

Following the All-on-4 Implant treatment, this gentleman can smile and eat confidently.

Final (Right Side)

Final (Left side)

Bridge Fitted

Dental hygiene for bridgework of this type is of utmost importance, spaces between the bridge and gum are present to allow for floss or interdental brushes to facilitate cleaning between the four implants & under the bridge.

The blockish-yellow colour of the lower bridgework is more apparent in comparison to the neutral colour of the new bridge, however this is functioning well currently, and the patient shown less of his lower teeth when smiling.

In a single appointment, the remaining upper teeth were extracted and 4 dental implants were placed, and a prototype non-removable fixed bridge was fitted. After a healing period over a few months, the prototype was modified and a definitive bridge supported by the 4 implants was finally delivered. For this patient, we strived to give him a more natural appearance, rather than match the colour of his existing lower bridge. The implant is secure and provides similar chewing efficiency to his natural teeth, it is expected to last many years with minimal maintenance.

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