Upper and Lower ‘All-On-X’
This has to be one of my favorite before-after reveals because it shows just how much detail can go into transforming these cases!
Not all offices that do ‘full arch’/hybrids/’all-on-x’/’All-On-4’ are made equal. There are a lot of approaches clinicians take to the process, and this patient experienced part of our ‘evolution’ as we worked out our digital workflow. We also focused on getting the prosthetics and bite PERFECT!
This patient had lost his anterior teeth when he was young, and had a maxillary partial fabricated. The work was well done utilizing precision attachments to avoid clasps, but still not super functional. He was also missing his lower posterior teeth and was wearing a lower partial. Sadly it dropped on the floor and broke, and he was ready to be able to eat REAL food again! We suggested upper and lower hybrids, and got him in for surgery ASAP!
His case was anatomically difficult. Due to the bone loss in the areas where teeth were already missing, we had a hard time, especially on the lower arch. I am always willing to admit when there was something I could have done better, and I admit I could have taken more mandibular anterior bone and cheated the lower right implant more mesial. I am always worried about the nerve on the bottom, and he just didnt have much bone above his!
On the maxillary arch, we focused on prosthetics and making the occlusal plane level with his eyes, and his ‘Frankfurt’ plane. On the lower, we focused on restoring posterior teeth.
Our original digital workflow involved patients coming back in a few days to get temporary teeth seated. That is what we did here – the lab made the teeth and we seated them two days later. Bite was excellent, and we let him heal. I of course wanted to adjust the maxillary occlusal plane.
After 3 months, we moved on to making his final Zirconia prosthetics. We spent some time adjusting the bite to make it perfect, but ended up with a prosthetic failure at the distal implant on the lower left. After analysis with our lab partner, SYNrG Lab, we determined that we needed to swap for a lower titanium appliance, swap MUA’s to get a bit more restorative space, and attempt placement of an even more distal implant. Thankfully, BioHorizons makes a 6mm ‘shorty’ implant and we found a spot with ~7mm of bone. After careful CBCT analysis, we placed an implant and waited. During that time, we had him wear a 3D printed temporary on the lower with a shorter cantilever — the evolution of our digital workflow!
After that last implant healed (thankfully with no nerve issues!) we made a new lower Titanium prosthetic. Here are the results, we were so happy – but not as happy as the patient. For the first time in decades, he could bite into a sandwich!
Huge shoutout to SYNrG Lab for their partnership on this case — these ceramic results rival work done with traditional crown/bridge and are absolutely insane to see in the ‘full arch’ space!
Thanks for trusting us with your smile, bite, function, and confidence! For more information about implants, options for restoring your smile, or the differences between fixed and removable implant solutions, follow us on Instagram @FantaskiSmiles and send a DM with any questions. To schedule a consultation, please call (678) 845-8658.