Case Study
This case demonstrates a practical approach to full mouth restoration in a 68-year-old male patient who presented with e · Dr. Rodney Andrus
This case demonstrates a practical approach to full mouth restoration in a 68-year-old male patient who presented with extensive dental deterioration. Treatment combined fixed implant-supported bridges in the lower posterior regions with an immediate complete removable denture for the upper arch. The case highlights how careful case selection and attention to anatomic features can guide treatment decisions toward solutions that balance clinical outcomes with patient priorities including maintenance simplicity and financial considerations.
Patient MH, a 68-year-old male, presented with extensive dental problems affecting both his upper and lower arches. His overall dental condition required comprehensive intervention to restore both function and aesthetics. The patient's oral anatomy presented both favorable and unfavorable features that would influence treatment planning decisions.
The patient's primary concern was that his teeth were in bad shape. This generalized complaint reflected the extent of deterioration throughout his dentition and his recognition that comprehensive treatment would be necessary.
Clinical examination revealed multiple active cavities, abscesses, missing teeth, and unsatisfactory existing restorations throughout both arches. The lower arch presented an unfavorable form with poor ridge anatomy and lateral throat form that would complicate removable prosthetic options. In contrast, the upper arch demonstrated favorable anatomy for a complete denture including abundant keratinized tissue support, low frenum height, and favorable posterior palatal form angle. These anatomic features would support denture retention and stability in the maxillary arch.
For the lower posterior teeth, the primary options included fixed implant-supported bridges or a removable partial denture. For the upper arch, treatment options included an immediate complete removable denture or fixed implant-supported teeth. The patient's anatomic features, financial considerations, and maintenance preferences all factored into the evaluation of these alternatives.
The treatment plan selected for this patient consisted of fixed implant bridges to replace the lower back teeth, providing a stable fixed solution in the posterior mandible. For the upper arch, an immediate complete removable denture was chosen. This selection was based on the patient's financial situation, the simpler maintenance requirements of a removable prosthesis, and the high likelihood of success given the favorable upper jaw anatomic features that would support denture retention and function.
Implant bridges for the lower back teeth were selected to allow the patient to function without experiencing the disadvantages associated with a lower removable partial denture. Removable partial dentures in the lower arch can be less stable and more difficult to adapt to, particularly in patients with unfavorable ridge anatomy.
For the upper arch, an immediate complete removable denture was chosen over fixed implant-supported teeth for several important reasons. Financial considerations made the removable option more accessible for this patient. The maintenance requirements for a complete denture are simpler compared to fixed implant restorations. Most importantly, the favorable upper jaw features including abundant keratinized tissue, low frenum attachments, and favorable palatal anatomy indicated a high likelihood of success with a conventional denture approach.
Additionally, the patient had very limited bone available for dental implants in the posterior regions of the upper jaw. Providing posterior dental implants in these areas would have been problematic and would have required more extensive surgical intervention such as bone grafting procedures.
This case illustrates the value of prosthodontic training in recognizing when a conventional denture approach represents an appropriate treatment option. The ability to identify favorable ridge anatomy and tissue characteristics for complete denture success opens the door to treatment alternatives that may be more suitable for certain patients than expensive, irreversible, high-maintenance fixed implant surgery. Understanding when denture treatment can provide predictable results allows for treatment planning that aligns with patient values and circumstances.
Treatment began with extraction of the remaining compromised teeth in both arches. Dental implants were then placed in the lower posterior regions to support the planned fixed bridges. After a period of healing and integration, the lower implants were restored with fixed prostheses. For the upper arch, an immediate complete denture was fabricated and delivered at the time of the upper extractions. This immediate denture required subsequent adjustment and relining procedures as the tissues healed and remodeled following the extractions.
The lower posterior restorations utilized Straumann tissue-level dental implants with screw-retained zirconia bridges. For the upper complete denture, IVOCLAR Blueline DCL acrylic denture teeth were selected and arranged according to esthetic principles and to establish balanced articulation for functional stability. The denture teeth were then flasked and processed with high-impact injected acrylic denture resin to create a durable prosthetic foundation.
As anticipated with immediate denture treatment, the upper denture fit loosened as the extraction sites healed. The tissues underwent normal healing and remodeling, which resulted in changes to the ridge contours and reduced denture adaptation. This expected complication was managed systematically with a temporary soft reline performed after a few weeks to improve the immediate fit and comfort. After several months, when tissue healing had stabilized, a definitive hard reline procedure was completed.
The definitive reline process involved careful attention to technique to optimize the denture foundation. The denture borders were molded with modeling plastic to capture the limiting anatomic areas and to create an effective peripheral seal. Perforations were placed over the secondary stress-bearing areas of the denture base. This technique directed functional pressures toward the primary stress-bearing areas of the ridge, which improves load distribution and denture stability.
A master mucostatic impression was made using light-viscosity polyvinyl siloxane impression material to accurately capture the supporting tissues under minimal pressure. For the posterior palatal seal area, Iowa impression wax was utilized with the fluid wax technique to create a physiologic seal that enhances retention without causing tissue trauma or discomfort.
At three years following treatment completion, the patient reports continued satisfaction with both the esthetics and retention of his prostheses. He specifically states that he can eat whatever he wants, indicating successful restoration of masticatory function. The implant bridges in the lower posterior regions have remained stable and functional. The upper complete denture continues to provide adequate retention and function.
The initial complication of denture loosening due to tissue healing was successfully managed through the planned temporary and definitive reline procedures. The patient has maintained functional status without additional complications. His satisfaction with the treatment outcome reflects the success of matching the treatment approach to his anatomic features, functional needs, and personal priorities.
Not all patients need a Ferrari. This case demonstrates that recognizing favorable anatomic conditions for denture treatment, combined with attention to proper clinical technique, can open appropriate treatment options for select patients who value simpler maintenance or have moderate financial resources. The ability to identify when conventional prosthodontic approaches can achieve predictable success allows clinicians to offer treatment plans that align with patient circumstances while still delivering functional and esthetic results. Understanding the full range of treatment options, including when more conservative approaches are clinically appropriate, serves patients better than defaulting to the most complex or expensive solutions.
The upper arch presented favorable anatomy for a complete denture including abundant keratinized tissue, low frenum attachments, and favorable palatal form. These features indicated a high likelihood of success with a conventional denture. Additionally, there was very limited bone available in the posterior upper jaw for implant placement, which would have made implant treatment problematic and would have required extensive bone grafting. The denture option also provided simpler maintenance and was more aligned with the patient's financial situation.
An immediate denture is fabricated before the teeth are extracted and delivered at the time of extraction. This allows the patient to have teeth immediately rather than going without teeth during the healing period. The tradeoff is that as the extraction sites heal and the tissues remodel, the denture fit changes and reline procedures are needed to re-establish proper adaptation to the tissues.
After teeth are extracted, the bone and soft tissues undergo a healing and remodeling process that changes the shape of the ridges. This is a normal and expected part of healing. As the ridges change shape, the denture no longer fits as closely to the tissues. Relining adds new material to the tissue side of the denture to re-establish close contact with the healed tissues, which improves both fit and retention.
The lower arch had unfavorable anatomy for a removable partial denture, including poor ridge form. A removable lower partial denture would have been less stable and more difficult to adapt to. Implant bridges provided a fixed stable solution for the lower back teeth. In contrast, the upper arch had very favorable anatomy for a complete denture and limited bone for posterior implants, making the denture the more appropriate choice for that arch.
In this case, a temporary soft reline was performed after a few weeks to improve comfort and fit during the early healing period. The definitive hard reline was completed after several months once the tissues had stabilized. The timing of reline procedures depends on how quickly the tissues heal and remodel, which varies among patients.
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