Smile and Bite Makeover with Upper and Lower All-On-4

Before

After

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Doctor’s Comments

This 55 year old lady had numerous missing teeth that were replaced with a denture. You can see in the before shot the metal clasps that are typical, which help stabilise the denture.  However, whilst replacing the missing teeth, the patient was unable to bite or chew many foods, and hated the look of her teeth.

Apart from the issues that this patient was aware of, there were other factors that had to be taken into account when considering the various alternatives and planning her treatment. She had a scissor bite on the left, a very narrow arch form giving her a narrow smile, back teeth that are supra-erupted because there were no teeth on the lower to bite against, and very thin gums.

One of the options considered was keeping the existing teeth and replacing only those missing with individual dental implants. However this treatment had many limitations. Firstly, when placing implants in thin-type gums, there is a predisposition to recession, and the this causes more unevenness in the gums as well as dark margins around the teeth.  Secondly, with individual implants we are unable to address the underlying problems with the bite, and arch form.

The patient came to our clinic for implants, but what she really wanted wasn’t ‘implants’. She wanted a nice smile and functional teeth. To give her that we had to remove the teeth, and this gave us the freedom to design her bite and aesthetics from the ground up.  We treated her with Upper and Lower All-On-4 in 2011 and fitted the permanent teeth seen in the after shot within 24 hours from her surgery.

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The three upper front teeth are denture teeth, held in by the metallic clasps on the sides. The rest of the teeth are compromised because of large restorations. Note the uneven occlusal plane, scissor-bite and extremely thin gums.

After the teeth were removed, four implants were placed in each jaw. This picture shows the lower implant bridge in place and the four fixtures that support the upper bridge.  Note the flatter interface, which simplifies cleaning under the bridge, and the stable thicker gum-type, the result of our augmentation procedures that we do as part of our All-On-4 process.

The x-ray illustrates the upper and lower All On 4 treatments.  To improve the durability of the teeth, a metal bar is incorporated into the bridge, visible as a horizontal white line. Two teeth were kept in the upper temporarily to help the patient figure out her new bite.