This is a difficult full arch implant case with a full upper arch reconstruction utilizing the zygomatic and pterygoid dental implants.
Let me explain why this case is more difficult than average. She was told by two other offices that they could only make her a snap-on denture. My office in Burbank, California was her third opinion.
She presents with a failing existing crown and bridgework on the upper. It is loose and about to fall out! Her original teeth were small for her face but overall, the smile line was okay.
What is the solution?
The solution for this full arch implant case was going to be where I remove the teeth, place the implants, scan on the day of the surgery and make computer-generated teeth using PMMA material. This is all based from a facial and dental scan and a lot of preplanning to get this kind of result.
The main issue is that she really had no bone at all!
What to consider with this full arch implants case
Her sinuses were so large that they expanded almost to her nose. Usually, the sinuses are localized to the very back teeth and don’t go so far forward. This makes the whole upper jaw maxilla hollow.
You can’t place screw type implants into a hollow jaw. You either have to build the bone back, which takes about a year, or you have to use remote anchorage type of implants like zygomatic or pterygoid implants.
Also from a skeletal standpoint, her upper jaw sits behind the lower jaw in a reverse, under bite, class 3 relationship. This means the implants themselves are placed further in the palate, but the teeth still have to project over the lower teeth and of course support and fill the lips properly while maintaining a convex shape for hygiene and longevity.
This is a really common error I see that causes a lot of problems if it is missed.
The result of the implants being further back and the teeth needing to be in the forward position for aesthetics and lip support makes it so the bridge has be thicker on the inside than I would prefer. Of course, I explain this in detail before the procedure and show numerous models so you can see everything beforehand.
The only other option would be to make an over denture which in 2023 in my opinion is unacceptable for a patient like this because that needs to be removed and requires a lot of maintenance.
Who wants to take their teeth out anyways! And you cannot place an overdenture on zygomatic implants.
The final bridge is made a few months after healing with the prototype temporary on the multiunit abutments. I’ve made sure to check for any gaps or any fit problems on the bridge before going to final. Any changes would happen prior to going to the final zirconia dental implant bridge.
What is the result?
- Final x-ray all on 6 dental implants utilizing zygomatic and pterygoid implants in a hollow upper jaw – Ramsey Amin DDS
The final result of this full arch implant case is beautiful and strong metal reinforced! Look at the x-ray. You can see that the whole upper jaw is hollow but the long pterygoid implants, zygomatic implants along with implants placed into the nasal base give awesome support without any damaging distal cantilever. I refer to this as “reverse AP spread.”
This full arch implant case was done without any bone grafting and completed in the office ONE surgical procedure under IV sedation. Wow!
Ramsey Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
It’s been a year and is since my all on 5 and I still don’t have my permanent teeth. The redesigns dont fit. After surgery I had an infection for months. Could this be a implant failure?
Oof. Might be time for a second opinion!