Tooth- and Implant- Supported Full Mouth Rehabilitation

The patient was unhappy with his smile due to the discoloured, chipped and worn anterior teeth as well as the missing upper right posterior teeth. He wanted to replace the missing teeth to improve his ability to masticate and enhance his smile.

Appropriate treatment options for teeth replacement (removable prostheses, bridges or implant restorations) and the rehabilitation of tooth wear (composite resin build-ups, onlays or crowns) were discussed. Initial management involved identifying and eliminating the cause of tooth wear.

A diagnostic wax-up was performed at an increased OVD. This was transferred and refined intraorally to ensure a harmonious smile and occlusal plane, and to determine the replacement volume of lost tooth structure. This diagnostic mock-up served as a template for both the provisional and definitive restorations. The reorganised occlusion was verified with long-term provisional restorations, provisional removable partial denture and direct composite resin build-ups on teeth 34 – 44.

Dual-scan CBCT assessment with radiographic templates revealed insufficient bone volume in the maxillary right posterior region. Implants were planned in the 14, 15, 16, 35, 36 and 46 sites and tooth-supported surgical guides were fabricated. The 14 and 15 implants were placed simultaneously with lateral-window sinus augmentation, while the 16 implant was placed in a staged approach 4 months later with the same surgical guide. After a period of provisionalisation, definitive tooth- and implant- supported PFM restorations were fabricated. A maxillary occlusal splint was issued to protect the rehabilitation.