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Rehabilitation of Terminal Dentition Complete Denture Opposing on All-on-5

Terminal mandibular dentition had progressively worsened since 2005, affecting the patient’s speech, comfort and confidence. Tooth loss stemmed from caries and periodontal disease years earlier, and a maxillary denture constructed a decade ago had never been well tolerated. As a past model, he found it difficult to eat, speak clearly or smile with confidence, and had spent 12 years relying on a bulky, loose upper plate that spent most of its time in his shirt pocket rather than his mouth.

Chief concerns

  • My lower teeth are mobile, I only use my top plate for eating, and it’s usually in my shirt pocket.
  • I 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.
  • Wanted prosthesis stability and comfort
  • Wanted an aesthetically pleasing complete removable denture
  • Want to improve my health.

This study will show

  • Complexity of treatmen
  • Treatment outcome
  • Patient’s assessment
  • Please refer to the video provided

Initial Presentation

The patient was referred by his dentist for a specialist opinion on fixed options to restore missing and failing teeth. He had retained his lower teeth out of fear of wearing a complete lower denture, given how unsuccessful the upper denture had already been. The upper arch was edentulous, and the lower arch presented with broken-down dentition and crowns, resulting in unacceptable aesthetics and function that had gone untreated for years while other priorities took precedence.

Diagnosis

Unacceptable dental aesthetics and function due to dissatisfaction with failing teeth, failing fixed restorations, and poor adaptation to the existing upper denture.

Treatment Aim:

To improve the aesthetics of the upper arch with a correctly constructed new denture for comfort and speech, followed by an implant-supported fixed lower bridgework. In cases of maladaptation to upper dentures, a well-fitting, aesthetic denture is trialled first. Only when a patient still cannot adapt, as was the case here, does upper fixed implant-supported bridgework become the next consideration.

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 bridge are both aesthetic and functional.

Treatment

  1. No treatment: not viable, as the failing restorations were compromising the longevity of supporting teeth
  2. Fixed option: implant-supported upper and lower fixed bridgework, given the intolerance to the upper denture
  3. Selected option: a new upper denture (which the patient could adapt to), paired with a new lower implant-supported fixed mandibular bridgework

Procedure & Results

An aesthetic, well-fitting maxillary complete denture was constructed first. This was followed by an immediate provisional implant-supported fixed denture prosthesis (ISFDP) for the lower arch, with the lower teeth removed and the provisional bridge constructed within hours of implant placement. Treatment was completed with minimal discomfort, and the patient was never left without teeth throughout the process.

Upper arch: complete maxillary prosthesis (laboratory) and implant-supported bridgework with tooth-supported crowns (clinical)

Lower arch: immediate provisional implant-supported fixed bridgework, placed the same day as implant surgery

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

Laboratory Completed Prostheses

Treatment was completed over six months to allow implants to properly integrate with the bone, prioritising biological healing over speed.

Final treatment outcome:

Aesthetics, comfort and function were fully restored, along with a meaningful improvement to the patient’s facial aesthetics. Most importantly, the outcome left a confident, happy patient.

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)

What Our Patients Say

Here are just a few reflections from patients featured in our case studies. Every story is different, but each one speaks to the power of feeling proud of your smile again.

I've been a customer of Designer Smiles for over 20 years and I cannot say enough good things about them! From the moment you walk into the office, you are greeted with a warm and friendly atmosphere that immediately puts you at ease. The staff is knowledgeable, professional, and caring. They use the latest technology and take the time to explain everything. I highly recommend them!

Ken Baumli

Dr Sarkis is the maestro of cosmetic dentistry….for years I suffered with 2 slightly darker front teeth due to a childhood accident. I’ve had composite veneers before but nothing compared to the composite veneers Dr Sarkis did……now I feel so confident smiling again……Dr Sarkis I can’t thank you enough…

Monica McKenzie

Quite literally the best dentist I’ve been to in a lifetime. Dr Natasha Koelmeyer specifically is just a wonderfully kind and gentle Doctor. Must also mention that the head specialist here is also second to none. Their knowledge (goodness they know their stuff) their approach, their kind and gentle manner - my daughter actually enjoys going to the dentist. They’ve got a really considered patient centric mentality. I wouldn’t go anywhere else, every single person there including the reception staff is a star. Thank you Designer Smiles!

Michelle Lacasse

My journey with Dr Sarkis began about 10 years ago. I did not realise that I had lacked self confidence and shone away from "my true smile". Dr Sarkis was honest, reassuring and professional throughout my process and not only was he able to achieve that perfect smile but achieve same without compromising the health of my teeth and gums.The ongoing care at Designer Smiles is 5 star whether it is a routine check, clean minor or major dentistry. Thank you Dr Sarkis and also your team.

Christina Vergotis

I found Designer Smiles from one of their YouTube videos showcasing the Icon treatment to fix white spots on teeth. Dr. Sarkis Nalbandian's consultation provided me with a thorough plan and showed me how their practise could give me predicable results for my concerns. I knew I was in safe hands. I had Kristy Gupta perform both of my procedures and she was very professional and so kind. I am very happy with my results!

Winsome Kain

I cannot express how grateful I am for Sarkis and the team at Designer Smiles. Around 11 years ago my life changed when Sarkis first transformed my smile with composite veneers. This month, with my original teeth in tact I returned to have my composite veneers upgraded to porcelain. I was amazed that Sarkis and his team could do this without an injections, no pain and whilst still keeping my original teeth in tact. I absolutely love the result and I would highly recommend that anyone that is unhappy with their smile in any way, must visit designer smiles

Matt Williams

Started my treatment with the team at Designer Smiles in 2019. Had other dental treatments including Maxillofacial, expanders, straightening and gum grafting but out of all the procedures and surgeries Dr. Sarkis was the key as he was applying the ‘finishing product’ which included composite veneers. I am gobsmacked by the incredible job done. He talks the talk and definitely walks the walk. And his support team there are simply incredible and make you feel part of a family not just another dental clinic to take your money. Can not recommend highly enough. Customer for life here!!

Shaun Meader
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Address: 17 Gerard St, Cremorne, Sydney,NSW, 2090

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