A 62-year-old woman with a long-standing complete upper denture and failing lower partial denture. Patient experienced significant bone resorption under her 20-year-old upper denture and could no longer wear it comfortably. Lower arch had 6 remaining teeth in varying condition. Comprehensive rehabilitation with 4 upper implants (overdenture) and a combination of lower crowns and 2 implants achieved excellent function and aesthetics.
Clinical Findings
Upper arch: completely edentulous. Significant alveolar bone resorption (Cawood & Howell Class V anteriorly, Class IV posteriorly). Existing complete upper denture — severely resorbed ridges. 20 years of denture wear. Lower arch: 6 remaining teeth (LR5, LR4 partially, LR2, LL2, LL3, LL4) in varying condition. LR3 — Grade III mobility, periapical lesion. LL5 — root caries extending subgingivally. Remaining lower teeth: mild periodontitis but salvageable. Partial lower denture — ill-fitting, unstable.
Occlusal Analysis
Existing denture occlusion unreliable due to resorption. New OVD planned 2 mm above existing denture OVD (confirmed by closest speaking space analysis). Centric relation recorded with upper edentulous tray. Lower occlusal plane reasonably maintained by retained teeth.
Removal of compromised lower teeth and healing period before surgical phase.
Procedures
Notes
Socket grafting at LR3 was essential to preserve bone volume for planned implant at LR4 region. Periodontal treatment of remaining lower teeth reduced bleeding scores from 58% to 11% — excellent response from patient who now uses electric toothbrush diligently.
Dramatic improvement in quality of life. Patient can now eat comfortably and no longer struggles with a loose denture. Upper implant-retained overdenture stable and retentive. Lower fixed bridge eliminates removable appliance entirely. OHRQoL improved from severely impaired to near-normal at 1-year review.
6-monthly hygienist visits. Annual bar tightening (15 Ncm) and O-ring replacement. Lower crowns and bridges: annual clinical and bitewing radiographic review. CBCT at 2 years for crestal bone assessment.
1-year review: all 6 implants stable. Upper bar and attachments intact. Overdenture teeth show minimal wear. Lower crowns and bridge intact. Patient reports "complete transformation" in quality of life. Maintenance programme: 6-monthly hygienist visits, annual implant review.
How did you handle the occlusal scheme post-treatment?
Great outcome! How long did osseointegration take before loading?
Great outcome! How long did osseointegration take before loading?
Beautiful aesthetics. The shade matching is perfect.
The radiographic follow-up would be great to see here.
How did you handle the occlusal scheme post-treatment?
The pre-op planning clearly paid off. Excellent outcome.
The pre-op planning clearly paid off. Excellent outcome.
How did you handle the occlusal scheme post-treatment?
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Placement of 4 maxillary implants using the All-on-4 tilted implant concept to avoid sinus grafting in posterior region.
Procedures
Notes
All-on-4 concept avoided need for sinus grafting in posterior maxilla — a significant advantage for this patient's healing timeline and cost. Tilted posterior implants engaged denser bone in anterior sinus wall. Patient's first comment post-sedation: "Are these my teeth now? They don't move!" — deeply moved.
Placement of 2 implants in the lower arch to anchor a fixed posterior bridge.
Procedures
Notes
Lower surgery performed 6 weeks after upper arch surgery. Staggered approach allowed patient to fully recover between procedures. LR4 implant at the lower torque value — conventional healing chosen for safety. All remaining lower teeth responded well to provisional crowns; no post-preparation sensitivity reported.
Fabrication and delivery of the definitive upper implant-retained bar overdenture.
Procedures
Notes
Patient preferred removable overdenture over fixed hybrid for ease of cleaning — important consideration for elderly patients with limited manual dexterity. Bar provides rigid splinting and dramatic retention. Patient demonstrated excellent independent insertion/removal technique at delivery appointment.
Delivery of definitive lower arch crowns and implant-supported bridge.
Procedures
Notes
Careful articulation required to balance lower fixed restorations against removable upper overdenture — an atypical combination requiring extra attention at try-in. T-Scan confirmed even bilateral load distribution. Final result: patient has fixed teeth in lower jaw and secure, retentive overdenture in upper jaw — a transformation from a desperate situation with two failing dentures.
