53 year old, Female - Centre for Prosthodontics

53 year old, Female

Patient:	53 year old, Female
Concerns:	Loose and drifted teeth – affecting cosmetic smile appearance, eating and chewing. Seeking opinion on “All-on-4” implant procedure for the replacement of all her teeth.
Diagnosis:	Severe periodontal (gum and bone) disease with signs of occlusal trauma (positional changes and tooth movement with biting). Multiple missing back teeth – severe shortened dental arch – inadequate number of teeth for satisfactory masticatory (eating and chewing) function. High smile lip line with full display of gum above upper front teeth.
Management:	Atraumatic extractions (removal) of all teeth, bone augmentation and surgical implant placements by a specialist periodontist. Construction of temporary upper and lower full arch implant supported acrylic bridges – to replace teeth within 1 week after tooth removal. Following gum and bone healing period Construction of final upper full arch implant supported ceramo-metal (porcelain fused to metal) bridge – “tooth coloured crowns” emerging from the gum to achieve natural and aesthetically / cosmetically pleasing result. Construction of final lower full arch implant supported metal-acrylic (hybrid) bridge – with “metal-acrylic margin” hidden by lower lip – providing a more affordable option given lower aesthetic / cosmetic demand (as compared to upper counterpart) with no display during talking and smiling. Note: This case is not suitable to have “All-on-4” implant procedure for the upper jaw. Unless excessive bone is removed from the upper jaw, it is impossible to create a natural and cosmetically / aesthetically pleasing smile and hide the “metal-acrylic margin” under the upper lip in a patient with high smile lip line.

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