Dental facelift: Rehabilitation of Terminal Dentition Complete denture opposing on All On-5 Case Study
Dental facelift: Rehabilitation of Terminal Dentition Complete denture opposing on All On-5 Case Study
Dental facelift: Rehabilitation of Terminal Dentition Complete denture opposing on All On-5 Case Study
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
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 the last 12 years, it’s 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”
Improving the aesthetic apperance of her smile. To improve the upper arch shape and smile line as well as tooth colour. This lovely patient wants to smile and chew her food confidently.
She was specifically concerned about recent dental work by another dentist causing protrusion and canting of upper central incisors creating an aesthetic disturbance
Patient was referred by her dentist, seeking specialist’s opinion and treatment in relation to fixed option of restoring missing teeth and failing dentition as well as tooth supported crowns.
The loss of teeth from failing bridgework has left considerable soft and hard tissue defects that required augmentation to create a base for tooth replacement.
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 is time for us.
In general, whenever possible, I would like to replace, or at least get close to the foundation bone and gum tissues to allow optimal tooth position in the arch that creates natural aesthetics.
Note Upper arch: broken-down dentition, discoloured crown margins, unnatural teeth: colour, form, progression and gum line.
Lower arch: Missing molars and premolars on lower right side.
Diagnosis: Unacceptable dental aesthetics and function due to dissatisfaction with failing fixed restorations and general tooth discolouration
Our Aim: to improve the aesthetics of upper arch: Tooth shape, display, tooth colour, length, symmetry and smile line in general, as well as replacing missing teeth: 23,24,14,16 using implant supported crowns and replacing existing faulty crowns with new ceramic crowns.
This was accomplished with minimal discomfort to the patient and she never left the practice without teeth. The provisional bridgework being both aesthetic and functional.
Following with discussion of all risks and treatment modalities with our patient that included:
- No treatment: this is not an option as the restorations are failing and affecting longevity of supporting teeth
- Repair existing restorations and make removable partial denture: this is a temporary measure and not accepted by the patient
- Fixed option: implant and tooth supported crowns and bridgework, described below
- Placement if implants: lower arch (at sites: 36, 44, 45 & 46) and upper arch (14, 16, 24, 25 & 27).
- Finalise the treatment with implant and tooth supported crowns and bridgework in the upper arch. The provisional restorations for that important confidence, for normative function, comfort and aesthetics.
Laboratory: Reconstruction of upper arch: implant supported bridgework and tooth supported crowns.
Clinical: Reconstruction of upper arch: implant supported bridgework and tooth supported crowns.
The work was completed in six months as implants were given time to integrate with bone. Is best not to rush biology and allow optimal healing.
Final treatment outcome: we have restored aesthetics, comfort and function and we have a happy patient.
Unfortunately, this work was initially completed by a dentist with minimal qualifications and experience. Hence the reason for patient seeking a specialist prosthodontist for correct diagnosis and treatment planning; providing an optimal outcome for this lovely patient.
Note improvement in lip thickness and support in combination with correcting protruding maxillary central incisors.
Final treatment outcome: we have restored aesthetics comfort and function.
However most importantly we have omplemented our lovely patient’s facial aesthetics. Hence the term: dentofacial rejuvenation.
Final treatment outcome and we have a confident and happy patient.
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