Lower All-On-4 with Keyhole Surgery and Upper All-On-4-Plus Dental Implants

The 74-year-old retiree presented with severe bone atrophy having worn dentures for over 30 years. The upper denture was loose and the lower denture was intolerable due to pain from compression of nerves that occurred with gradual bone atrophy over the years. She was not aware that there was an alternative until she saw something in a magazine and came to our clinic to determine. Before we could determine if she was a candidate we took x-rays and pictures. When our dentist took the photo (the before shot on the left) he asked this lady to smile and the upper denture was so loose that it dislodged on smiling and fell down. The picture was taken just as the denture was falling. She had the lower denture with her, but wore it in her pocket because she said it fitted better there than it did in her mouth.

As a result of severe bone atrophy that had taken place due to long term denture wearing, it was necessary to do bone grafting in the upper jaw before we could place implants to support a fixed bridge.

In the lower jaw there was marginally sufficient bone for All-On-4 implants and we were able to do this treatment using keyhole guided surgery, and fitted an immediate fixed bridge. By treating the lower, the fixed bridge helped stabilise the upper denture while the grafts were consolidating.

Once the grafts healed, we placed 6 implants in the upper jaw and fitted a permanent fixed bridge within 3-days from the surgery.

This treatment was done in 2008. Today, we have alternatives that allow us to treat patients with poor or thinning jaw bone, like this lady, with a fixed and a permanent solution within 24 hours of surgery.