Case Study
This case documents the treatment of a 61-year-old male patient who presented with generalized moderate to severe period · Dr. Sajid Baqai
This case documents the treatment of a 61-year-old male patient who presented with generalized moderate to severe periodontitis and no longer wanted to wear removable partial dentures. The treatment approach combined maxillary full mouth reconstruction using a four-implant supported snap-on overdenture with a properly designed mandibular partial denture. This combination approach provided the patient with improved retention, stability, and function while preserving bone for long-term prosthetic success.
The patient was a 61-year-old male who presented to Dr. Sajid Baqai at Detroit Dentist Dentures & Implants seeking definitive treatment for his failing dentition. He had been wearing partial dentures but was no longer satisfied with this removable prosthetic option and desired a more stable and comfortable solution for eating and daily function.
The patient's primary concern was that he wanted to get out of partials. He no longer wanted to rely on his partial dentures and was seeking a more permanent and comfortable restoration that would improve his ability to eat and smile with confidence.
Upon comprehensive examination, the patient presented with generalized moderate to severe periodontitis affecting all of his remaining natural dentition. The severity was particularly pronounced in the upper arch, where severe periodontitis was present throughout the maxillary dentition. Several periapical pathologies were noted on radiographic examination, including granulomas under tooth number five and tooth number thirty-two. CBCT imaging was utilized to analyze three-dimensional bone architecture, evaluate the presence and extent of infections, assess sinus anatomy, and identify arterial structures. This advanced imaging was essential for precise implant placement planning and to ensure adequate bone availability for future prosthetic success with appropriate anteroposterior spread of the implants.
Multiple treatment approaches were discussed with the patient to address his failing dentition and desire to move away from removable partial dentures. For the upper arch, a straightforward complete denture fabricated over a mandibular partial denture was presented as the most conservative and economical option. An alternative treatment plan involved placement of a snap-on denture supported by four implants in the maxillary arch, combined with a mandibular partial denture. This implant-supported option was discussed with the patient in terms of its benefits for retention of the prosthesis, elimination of the need for denture adhesives, and preservation of bone volume for the future success of the restoration.
After reviewing all options, the patient elected to proceed with a snap-on overdenture on the upper arch. This decision was based on several factors that were important to the patient: enhanced retention of the denture without relying on denture adhesives, and maintaining as much of his existing bone as possible to ensure future success of the restoration. The patient also agreed to have a new partial denture fabricated for the mandibular arch. It was explained to the patient that while partial dentures can be fabricated by different providers, proper design is critical for comfort and function. The treatment plan emphasized the importance of correct rest seats and clasping assemblies to make the partial denture comfortable and preserve the remaining natural teeth for as long as possible.
Treatment was initiated with the extraction of all remaining maxillary teeth. Following the extractions, collagen plugs were placed where necessary to assist with clotting and soft tissue healing. On the same surgical appointment, bone grafting material was placed in the extraction sites to preserve ridge dimensions. Four dental implants were surgically placed at tooth positions number four, number six, number eleven, and number thirteen to provide optimal anteroposterior spread for prosthetic support. These implant sites were immediately grafted with bone grafting material following placement. The implants were buried beneath the soft tissue and covered with bone grafting to allow for the four to six months of undisturbed healing time that was necessary for osseointegration in this case. An immediate complete denture was fabricated and inserted on the same day as the extractions and implant placements to provide the patient with teeth during the healing phase. For the mandibular arch, impressions were taken and a new partial denture was constructed with proper rest seats and clasping assemblies. The patient was provided with an interim lower denture for healing purposes during the initial phase of treatment.
The immediate and final dentures were constructed using acrylic PMMA (polymethyl methacrylate), which is a proven denture base material known for its strength, biocompatibility, and esthetic properties. Cone beam computed tomography (CBCT) was utilized as a critical diagnostic and treatment planning tool. The three-dimensional imaging provided by the CBCT scan allowed for precise analysis of the available bone volume, identification of any infections, evaluation of sinus anatomy and location, and mapping of arterial structures in the surgical field. This advanced imaging technology enabled precise placement of the dental implants with proper positioning and angulation to ensure their future success. The CBCT data also allowed for planning of an appropriate anteroposterior spread of the implants to provide optimal biomechanical support for the final snap-on overdenture prosthesis.
The primary challenge encountered during the course of this case was related to the patient's schedule rather than clinical complications. The patient travels frequently for personal or professional reasons, which made it difficult to have him come in at the appropriate times for routine follow-up care and prosthetic adjustments. Despite these scheduling difficulties, the patient understood the importance of follow-up appointments and managed to provide enough of his time so that the case could be properly followed to successful completion. The patient's cooperation and commitment to making himself available when necessary was instrumental in achieving the excellent final result.
The patient is very happy with his final snap-on overdenture on the upper arch. He is particularly pleased with the esthetic appearance of his new smile and the functional improvement it has provided. The patient loves the ability to eat his favorite foods, including ribs and other challenging food items that he could not comfortably manage with his previous partial dentures. He has been successfully fitted with a properly designed partial denture for the lower arch as well. While he returned for minor adjustments to the mandibular partial denture, which is a normal part of the adaptation process, he expressed high satisfaction with both his smile and his restored ability to chew, function, and smile with confidence again. The combination of the implant-supported maxillary overdenture and well-designed mandibular partial denture has given this patient a new lease on his quality of life.
This case illustrates an important principle in modern prosthodontic treatment planning: it is not always necessary to start a patient off with the most expensive treatments available. There is extreme value in retaining natural teeth for as long as possible to improve the patient's proprioception and chewing ability. Natural teeth allow patients to use their neurosensory system to better understand what they are trying to eat or chew, how much chewing is required before food is ready to swallow, and when it is actually ready for swallowing. This proprioceptive information can only be transferred from natural teeth during function. While implants that are connected to a prosthesis can eventually provide similar sensory knowledge with enough time, preserving natural dentition where clinically appropriate maintains this critical feedback system immediately. This neurosensory capability is essential for patients to be successful at chewing and contributes to a better prognosis for future oral function. In this case, retaining the mandibular natural teeth with a properly designed partial denture rather than extracting them and placing additional implants preserved the patient's proprioception while still dramatically improving his quality of life and function in the maxillary arch where the teeth were not salvageable.
A snap-on denture, also called an implant-retained overdenture, is supported by dental implants that are placed in the jawbone. The denture snaps onto these implants using special attachments, providing significantly better retention and stability than a conventional denture. Unlike regular dentures that rest on the gums and may require adhesives, snap-on dentures are held securely in place by the implants. This improved retention allows patients to eat more challenging foods with confidence and eliminates the need for denture adhesives. Additionally, the implants help preserve jawbone that would otherwise be lost after tooth extraction.
A cone beam CT (CBCT) scan provides three-dimensional imaging that is essential for precise implant treatment planning. This advanced imaging allows your dentist to analyze the volume and quality of available bone, identify any existing infections or pathology, evaluate the location of important anatomical structures such as sinuses and arteries, and plan the exact position and angulation of implants for optimal success. The CBCT scan ensures that implants are placed with the proper spacing and positioning to support your final prosthesis effectively and safely, reducing the risk of complications and improving long-term outcomes.
In this case, the implants required four to six months of healing time for proper osseointegration, which is the process by which the implants fuse with the surrounding bone. During this healing period, the implants are typically buried beneath the gum tissue and covered with bone grafting material to ensure undisturbed healing. An immediate denture is provided on the day of surgery so you have teeth during this healing phase. The exact healing time can vary depending on individual factors such as bone quality, overall health, and whether bone grafting was performed. Once the implants are fully integrated, the final snap-on denture can be fabricated and attached.
Whenever possible, it is valuable to retain natural teeth because they provide important sensory feedback that helps you understand what you are eating, how much you need to chew, and when food is ready to swallow. This proprioceptive information comes from the neurosensory system connected to natural tooth roots and cannot be immediately replaced by dental implants. However, when teeth have severe periodontitis with bone loss and infections, as in the upper arch in this case, they may not be salvageable and extraction becomes necessary. The treatment decision should be made on a case-by-case basis, weighing the condition of the teeth, the feasibility of successful treatment, and the long-term prognosis. A combination approach, such as implants where teeth cannot be saved and a partial denture where healthy teeth remain, can provide an excellent functional and cost-effective result.
A properly designed partial denture incorporates correct rest seats and clasping assemblies that are carefully planned to distribute forces evenly, provide adequate retention without damaging the remaining natural teeth, and ensure patient comfort during function. Rest seats are precisely prepared areas on natural teeth that support the partial denture and prevent it from settling into the soft tissue. Proper clasping assemblies hold the partial denture securely without placing excessive pressure on the teeth. When designed correctly with these features, a partial denture can be comfortable to wear, preserve the remaining natural teeth for many years, and provide good chewing function. In contrast, a poorly designed partial denture may cause discomfort, accelerate the loss of remaining teeth through improper force distribution, and function inadequately during eating and speaking.
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