Case Study
This case documents the full mouth reconstruction of a 61-year-old male patient with severe periodontitis who desired a · Dr. Sajid Baqai
This case documents the full mouth reconstruction of a 61-year-old male patient with severe periodontitis who desired a fixed alternative to removable partial dentures. The treatment involved full maxillary extraction, placement of four implants with immediate bone grafting, and delivery of an immediate denture followed by a definitive snap-on overdenture. A mandibular partial denture was also fabricated to replace missing lower teeth while preserving remaining natural dentition.
The patient is a 61-year-old male who presented seeking a more stable and functional restoration. He was dissatisfied with his existing partial dentures and wanted a solution that would improve retention, function, and long-term bone preservation.
The patient's primary concern was his desire to eliminate the need for partial dentures. He no longer wanted to rely on removable prosthetics and sought a more stable and comfortable alternative.
Clinical and radiographic examination revealed generalized moderate to severe periodontitis affecting all remaining dentition. The upper arch demonstrated primarily severe periodontitis with multiple periapical pathologies noted, including granulomas under tooth number five. CBCT imaging was utilized to assess available bone volume, identify infections, and evaluate anatomical structures including sinuses and arteries to plan precise implant placement.
Two primary treatment approaches were discussed with the patient for the maxillary arch. The first option was a straightforward complete denture over a mandibular partial denture. The second option involved a snap-on overdenture supported by four implants in the upper arch, combined with a mandibular partial denture to preserve remaining natural teeth and bone structure.
The patient elected to proceed with the snap-on overdenture supported by four maxillary implants. This option was chosen for several key reasons: improved denture retention without the need for adhesives, preservation of alveolar bone for future restoration success, and enhanced function and comfort. Additionally, a new mandibular partial denture was planned with proper rest seats and clasping assemblies to ensure patient comfort and optimal function while preserving the remaining lower natural teeth.
The treatment was executed in a comprehensive single-visit surgical phase followed by a restorative phase. Full extraction of all maxillary teeth was performed on the same day as implant placement. Collagen plugs were placed in extraction sites where necessary to assist with hemostasis and clotting. Four implants were strategically placed at tooth positions number four, six, eleven, and thirteen to achieve proper anteroposterior spread and load distribution. Bone grafting was immediately placed around the implants to support osseointegration and preserve ridge dimensions. The implants were buried and covered with bone graft material to allow for four to six months of undisturbed healing. An immediate complete denture was fabricated and delivered the same day to provide immediate esthetics and function during the healing period. Lower impressions were also taken, and an interim lower partial denture was provided for healing purposes.
Acrylic PMMA was utilized to fabricate both the immediate and definitive denture prostheses. Cone beam computed tomography (CBCT) was employed to obtain three-dimensional imaging of the maxillary and mandibular arches. This advanced imaging enabled precise evaluation of bone quality and quantity, identification of existing infections, and detailed visualization of critical anatomical structures such as sinuses and arteries. The CBCT data facilitated accurate planning of implant positioning to ensure proper anteroposterior spread and angulation for long-term restoration success.
The primary challenge encountered during this case was the patient's frequent travel schedule, which made it difficult to coordinate timely follow-up appointments. Despite this logistical obstacle, the patient was cooperative and provided sufficient availability to allow proper monitoring and successful case completion.
The patient expressed high satisfaction with the final snap-on overdenture on the maxillary arch. He appreciated the esthetic appearance, improved retention, and enhanced ability to eat his favorite foods, including challenging items such as ribs. The mandibular partial denture was also successfully delivered, and minor adjustments were made to optimize fit and comfort. Overall, the patient was extremely pleased with his restored smile, chewing function, and ability to confidently interact socially.
This case illustrates that the most expensive treatment option is not always the most appropriate. Preserving natural dentition whenever feasible offers significant advantages, particularly in terms of proprioception and neurosensory feedback. Natural teeth provide critical sensory information that enables patients to better understand the texture, consistency, and readiness of food for swallowing. While implant-supported prostheses can eventually restore some degree of sensory feedback over time, the value of retaining natural teeth should not be underestimated. This approach not only enhances immediate function but also contributes to a better long-term prognosis for oral health and overall quality of life.
A snap-on overdenture is a type of removable denture that attaches to dental implants using special connectors. These connectors snap securely onto the implants, providing much greater retention and stability than a traditional denture. The denture can still be removed for cleaning, but it stays firmly in place during eating and speaking without the need for adhesives.
Four implants placed at strategic positions provide excellent support and retention for a maxillary overdenture when positioned with proper anteroposterior spread. This configuration balances clinical effectiveness with cost considerations, allowing for adequate load distribution and stability while avoiding the complexity and expense of placing additional implants. The placement at positions number four, six, eleven, and thirteen ensures optimal biomechanical support.
Yes, patients with snap-on overdentures typically experience significantly improved chewing function compared to conventional dentures. The secure attachment to implants allows patients to eat a wider variety of foods, including challenging items such as ribs and other foods that would be difficult with traditional dentures. The stability provided by the implants eliminates concerns about the denture shifting during meals.
Bone grafting was performed immediately after implant placement to support successful osseointegration and preserve the dimensions of the alveolar ridge. When teeth are extracted and implants are placed simultaneously, bone graft material helps fill gaps around the implants and prevents bone resorption during the healing period. This approach maximizes long-term implant success and maintains proper ridge contour for the final prosthesis.
This treatment involves multiple phases over several months. An immediate denture is placed on the same day as tooth extraction and implant placement to provide function and esthetics during healing. The implants are then allowed to heal undisturbed for four to six months to achieve proper osseointegration with the bone. After this healing period, the definitive snap-on overdenture is fabricated and delivered. Additional adjustments may be made as needed to optimize comfort and fit.
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