Case Study
This case documents the comprehensive treatment of a 61-year-old male patient who presented with generalized moderate to · Dr. Sajid Baqai
This case documents the comprehensive treatment of a 61-year-old male patient who presented with generalized moderate to severe periodontitis affecting all remaining dentition. The patient sought to eliminate the need for removable partial dentures and achieve improved function and retention. Treatment involved full maxillary extractions, immediate placement of four implants, bone grafting, delivery of an immediate snap-on overdenture, and fabrication of a new mandibular partial denture. The patient achieved excellent functional and aesthetic outcomes while preserving bone for long-term success.
The patient is a 61-year-old male who presented seeking alternatives to his existing partial dentures. He expressed a strong desire to eliminate the use of removable partials and achieve better retention, function, and aesthetics. He understood the importance of preserving remaining bone structure and was motivated to pursue treatment that would provide long-term stability and improved quality of life.
The patient's primary concern was his dissatisfaction with partial dentures. He no longer wanted to continue wearing removable partials and was seeking a more stable, comfortable, and functional solution that would allow him to eat his favorite foods and smile with confidence.
Clinical examination and diagnostic imaging revealed generalized moderate to severe periodontitis affecting all of the patient's remaining dentition. The upper arch demonstrated primarily severe periodontitis with advanced bone loss and compromised tooth stability. Radiographic evaluation identified several periapical pathologies, specifically granulomas present under tooth number five and tooth number thirty-two. A cone beam computed tomography (CBCT) scan was performed to evaluate three-dimensional bone anatomy, assess the presence of infections, map the location of sinuses and arteries, and plan precise implant placement positions for optimal anteroposterior spread and future prosthetic success.
Several treatment approaches were discussed with the patient to address his maxillary and mandibular dental needs. For the upper arch, the first option presented was a straightforward complete denture fabricated over a mandibular partial denture. This represented the most conservative and economical approach. The second option discussed was a snap-on overdenture supported by four implants placed in the maxillary arch, combined with a mandibular partial denture. This option would provide significantly improved retention, eliminate the need for denture adhesives, preserve alveolar bone through implant stimulation, and offer superior function and patient satisfaction. For the lower arch, fabrication of a new partial denture with properly designed rest seats and clasping assemblies was recommended to replace his existing poorly fitting partial.
After thorough discussion of the benefits and limitations of each treatment option, the patient elected to proceed with a snap-on overdenture for the upper arch supported by four implants. His primary motivations for selecting this approach included achieving superior retention of the denture without relying on adhesives, maintaining as much alveolar bone as possible through implant osseointegration for future success of the restoration, and optimizing long-term function and comfort. For the mandibular arch, the patient agreed to have a new partial denture fabricated. He was educated that partial dentures can vary significantly in quality depending on the provider, and that proper design with appropriate rest seats and clasping assemblies is essential for patient comfort and tissue health. This combined approach would provide him with the stability and function he desired while respecting his anatomical realities and maintaining remaining natural dentition where appropriate.
Treatment was initiated with extraction of all remaining maxillary teeth due to severe periodontitis and periapical pathology. Following extractions, collagen plugs were placed where necessary to facilitate proper clotting and soft tissue healing. Bone grafting material was placed at the extraction sites on the same day as the extractions to preserve alveolar ridge dimensions and support future prosthetic success. Four dental implants were placed at tooth positions number four, six, eleven, and thirteen to achieve proper anteroposterior spread and biomechanical distribution of occlusal forces. The implant sites were grafted immediately after placement to enhance primary stability and promote osseointegration. The implants were buried beneath the soft tissue to allow undisturbed healing. An immediate complete denture was fabricated and delivered on the same day of surgery to provide the patient with immediate function and aesthetics during the healing phase. For the mandibular arch, impressions were taken and a new partial denture was fabricated with proper rest seats and retentive clasping assemblies. An interim denture was provided for the lower arch to allow tissues to heal appropriately before final delivery of the definitive partial denture.
Acrylic polymethyl methacrylate (PMMA) was used to construct both the maxillary immediate denture and the mandibular partial denture, providing durable and aesthetic prosthetic materials. A cone beam computed tomography (CBCT) scan was utilized to obtain precise three-dimensional imaging of the available bone volume, identify the presence of infections and periapical pathologies, map critical anatomical structures including the maxillary sinuses and vascular channels, and plan accurate implant placement trajectories. This advanced imaging allowed for optimal anteroposterior spread of the four implants to maximize biomechanical stability and long-term prosthetic success. Bone grafting material was placed at all extraction sites and around the implants on the day of surgery to preserve ridge dimensions and support osseointegration. Collagen plugs were used selectively to control bleeding and promote clot formation. The immediate denture was designed to be converted to a snap-on overdenture once the implants achieved osseointegration after a healing period of four to six months.
The primary challenge encountered during this case was related to the patient's lifestyle rather than clinical complications. The patient travels frequently for work or personal reasons, which made it difficult to schedule him for follow-up appointments at the optimal intervals recommended for proper case management and monitoring. Consistent post-operative follow-up is important for assessing healing, making necessary adjustments to interim prosthetics, and ensuring that osseointegration is progressing as expected. Despite his travel schedule, the patient was cooperative and managed to provide sufficient time for critical appointments, allowing the case to be followed through to successful completion. The patient is returning today for final photographs and delivery of his lower partial denture, demonstrating his commitment to completing the treatment process.
The patient achieved an excellent outcome and expressed a high degree of satisfaction with his treatment results. He is very happy with the appearance and function of his final snap-on overdenture on the upper arch. He particularly appreciates the improved retention and stability, which allows him to eat his favorite foods, including challenging items like ribs, without concern about denture displacement or the need for adhesives. The patient has been fitted with his new mandibular partial denture and is presenting for minor adjustments to optimize comfort and occlusion. Overall, he is extremely pleased with his restored smile, his ability to chew effectively, and his renewed confidence in social and functional situations. The combination of implant-supported retention in the maxilla and a properly designed partial denture in the mandible has restored both function and aesthetics while preserving remaining bone and natural dentition.
This case illustrates an important principle in treatment planning: it is not always necessary to start a patient with the most expensive or complex treatment available. There is significant value in retaining natural teeth for as long as clinically appropriate to preserve the patient's proprioception and neurosensory feedback during chewing. Natural teeth provide essential sensory information that allows patients to better understand what they are eating, how much force is required for adequate mastication, and when food is ready to be swallowed. This sensory knowledge contributes directly to functional success and patient satisfaction. When natural teeth must be replaced with implants and a prosthesis, it takes time for patients to adapt and develop a new sensory relationship with their restoration. However, with adequate healing and adaptation time, implants connected to a prosthesis can eventually allow the patient to regain much of this sensory knowledge, leading to successful chewing function and a better long-term prognosis. Thoughtful, patient-centered treatment planning that balances function, bone preservation, cost, and realistic expectations is essential for achieving sustainable outcomes.
A snap-on denture, also called an implant-supported overdenture, is a removable denture that attaches to dental implants using special connectors. Unlike a regular denture that rests on the gums and may require adhesives for retention, a snap-on denture locks securely onto implants placed in the jawbone. This provides significantly better stability, improved chewing function, elimination of the need for messy adhesives, and preservation of jawbone through implant stimulation. Patients can remove the denture for cleaning but enjoy much greater confidence and comfort during eating and speaking.
Four implants were selected for this case to achieve an optimal anteroposterior spread, meaning the implants were distributed from front to back across the upper jaw to provide balanced support and stability. This configuration is a well-established treatment approach that offers excellent retention and biomechanical distribution of chewing forces while remaining cost-effective. The implants were placed at positions four, six, eleven, and thirteen based on available bone volume and anatomical considerations identified through CBCT imaging. This arrangement provides sufficient support for a snap-on overdenture while preserving bone and allowing for long-term prosthetic success.
Bone grafting was performed for two important reasons. First, when teeth are extracted, the surrounding bone naturally resorbs or shrinks over time, which can compromise the ridge shape needed to support a denture. Placing bone graft material at extraction sites helps preserve the dimensions of the alveolar ridge. Second, bone grafting around the implants at the time of placement enhances primary stability, supports the osseointegration process, and ensures adequate bone volume surrounds the implant threads. This increases the likelihood of successful implant integration and long-term stability of the snap-on denture.
In this case, the implants were buried beneath the gum tissue and allowed to heal undisturbed for four to six months. During this healing period, a process called osseointegration occurs, in which the bone grows directly onto the implant surface, creating a strong and stable foundation. An immediate denture was worn during this time to provide function and aesthetics. Once osseointegration was confirmed, the implants were uncovered and the immediate denture was converted to a snap-on overdenture by attaching the appropriate connectors. This staged approach ensures the best long-term success for implant-supported prosthetics.
The treatment plan for the lower arch focused on replacing missing teeth with a properly designed partial denture rather than additional implants based on the patient's specific needs, remaining natural dentition, and treatment goals. Retaining natural teeth in the lower arch provides valuable proprioception and sensory feedback that aids in chewing function. A well-made partial denture with proper rest seats and clasping assemblies can be very comfortable and functional while being more conservative and cost-effective. This approach allowed the patient to benefit from implant retention where it was most needed in the upper arch while preserving healthy lower teeth and avoiding unnecessary treatment complexity.
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