Lower All-On-4 with Keyhole Surgery and Upper All-On-4-Plus Dental Implants

Before

After

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Doctor’s Comments

The 74 year old retiree presented with severe bone atrophy having worn dentures for over 30 years. The upper denture was loose and the lower denture was intolerable due to pain from compression of nerves that occurred with gradual bone atrophy over the years.  She was not aware that there was an alternative until she saw something in a magazine and came to our clinic to determine.  Before we could determine if she was a candidate we took x-rays and pictures.  When our dentist took the photo (the before shot on the left) he asked this lady to smile and the upper denture was so loose that it dislodged on smiling and fell down.  The picture was taken just as the denture was falling.  She had the lower denture with her, but wore it in her pocket because she said it fitted better there than it did in her mouth.

As a result of severe bone atrophy that had taken place due to long term denture wearing, it was necessary to do bone grafting in the upper jaw before we could place implants to support a fixed bridge.

In the lower jaw there was marginally sufficient bone for All-On-4 implants and we were able to do this treatment using keyhole guided surgery, and fitted an immediate fixed bridge. By treating the lower, the fixed bridge helped stabilise the upper denture while the grafts were consolidating.

Once the grafts healed, we placed 6 implants in the upper jaw and fitted a permanent fixed bridge within 3-days from the surgery.

This treatment was done in 2008. Today, we have alternatives that allow us to treat patients with poor or thinning jaw bone, like this lady, with a fixed and a permanent solution within 24 hours of surgery.

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Severe bone atrophy as a result of long term denture wearing. The lower denture was intolerable due to pain from compression of nerves.

A computer-guided surgical stent (Nobel Guide) was fitted in the lower to guide the pre-planned positioning of the lower fixtures.

After the implants were placed the gums were closed with dissolvable sutures. White comfort caps were fitted whilst the teeth were being fabricated.

An impression of the implants taken immediately after surgery was used to make a model for the construction of the bridge.

Fixed lower replacement teeth are fabricated using highly aesthetic high-impact acrylic.

The lower replacement teeth are fitted to the implants with tiny screws through the back and fixed in position.

Bone grafting was performed in the upper jaw and left to heal. The patient continued to wear her upper denture during the healing process.

After healing of the grafts, six dental implants were placed using Nobel-Guide computer guided keyhole surgery. Comfort caps were placed whilst the teeth were being fabricated. Note that there are no stitches with this keyhole surgical method.

In the next day, teeth were set in wax in and tried in over the implants to assess function, aesthetics, comfort and speech. Once all parameters are met, the case is sent for fabrication.

The upper replacement teeth are fabricated using highly aesthetic high-impact acrylic.

The upper replacement teeth are permanently attached to the implants with tiny screws through the back and the patient can throw away her dentures.