Smile in a day/ All-on-4™ : A patient case study

The Patient

The patient featured in this case study was most concerned about his failing upper teeth which suffered from repeated breakages and infection. More importantly, both his dental function and appearance were deteriorating. Using the Nobel Biocare All-on-4® system, we were able to offer our patient a brand new “Smile in a day” by correcting his multiple dental deficiencies in just five hours.

The patient presented with:

• Class three facial anatomy
• Prominent chin
• Increased vertical face height
• Unsightly uneven and discoloured front teeth
• Anterior open bite
• Uncomfortable indefinite ICP on failing back teeth
• Not confident
• Not Smiling

Pre op planning

A CBCT scan was taken prior to surgery to help with the planning of the implant placements. A new upper denture was also constructed at the correct OVD having previously established tooth colour, size and position with the patient to achieve his desired appearance. This allowed us to:

Rearrange the position of the new arch of upper teeth to eliminate the patient’s anterior open bite
Reduce his occlusal vertical dimension by 9 mm
Position his new aesthetic front teeth in a class one occlusion with his natural lower front teeth.

Surgery

Surgery was completed in around two hours which involved the:

• Removal of the failing upper teeth
• Reduction in the alveolar bone ridge height
• Placement of four Nobel Speedy Groovy implants in the classic All–on-4® positions.

The pre-prepared upper denture was used as a surgical guide ensuring the pre planned protocols were applied accurately.The patient relaxed in our private recovery room while the full upper denture, which was used as the template, was converted into the immediate implant supported bridge. This technical work was completed in two hours at our onsite Dental Laboratory. The immediate bridge was then attached to the implants using four prosthetic screws. Each screw was neatly hidden under a small composite filling. The new bite on the immediate bridge was finalised with minor adjustments. This patient was able to leave with a fixed temporary bridge looking great and happy.

Post op

Minimal post op discomfort was achieved using an effective anti-inflammatory drugs combination for a week. After one month, the patient was cleaning easily and comfortably around and under the new bridge. A few months later, we replaced the temporary bridge with a Cad Cam titanium substructure supporting identical acrylic teeth. The permanent bridge included an additional tooth on each side.

The Results

The patient was thrilled with his new teeth and since treatment, has experienced a new confidence. As well as replacing his failing teeth with a reliable and healthy set, we have provided him with a set of teeth that look better than any he has ever had in his life. He has started smiling again, and grins confidently.

After treatment

Using the well established Nobel Biocare All-on-4® protocols with some clever adaptions to suit this particular patient, like 250 other Devonshire House patients, he benefitted from this life changing “Smile in a Day” treatment.