This blog will cover one of my patients wearing a fill-fitting upper removable partial denture. The denture was not stable and fell down whenever he opened his mouth. There were no retentions because the patient only had two teeth left that were unable to keep the denture from moving and falling down. His existing denture was severely worn down, and his lower jaw was closing up further, making his lower face height look short. When he smiled, only his lower front teeth were visible resulting in the need for a new implant-supported upper denture.
1 Only two teeth left on the upper
2 The implant-supported upper denture in the month. Note the denture was broken, teeth were worn down and not occluding with the lower teeth properly
3 The upper teeth not showing when the patient was smiling
The other challenges were his overly long lower front teeth in his fixed bridge and his heavy, powerful bite while chewing. He cracked his upper denture multiple times because of his strong biting force and hard food diet. He expressed his desire to have a more stable set of teeth for the upper arch so that he can do chewing without worrying about falling.
I went through the different options to replace his broken upper denture, namely, no treatment at all, a zirconia hybrid bridge supported by six implants, an implant-supported removable denture, and simply a complete removable full denture using the palate for support and suction/retention. The possibility of repairing and relining his existing denture was also presented and discussed with the patient. If he had chosen the last option, he would always need to use denture adhesive. After thoroughly examining the different options, the patient decided to have four implants placed and a new removable partial denture.
Since the patient was involved in a traumatic accident many years ago that knocked out most of his upper front teeth, the amount of lost jaw bone was severe. The height of the jaw bone at the back was short, as the floors of the sinuses were very low. Not many areas along the upper jaw arch had a sufficient bone to place implants without extensive bone grafting. We decided to do an implant-support denture that is removable yet securely stabilized by the clips or buttons called Locators, after considering numerous factors like suitability, the amount of surgery that the patient is willing to go through, the financial burden, the time involved, and the uncertain outcomes of more complex surgeries to increase bond dimensions.
4 The Pan X-ray shows insufficient bone height on the right side of the upper jaw and decay in some of his lower teeth
Indirect sinus lift and guide tissue regeneration techniques were employed to augment the bone for the four implants. An immediate implant was to replace the canine after it was extracted. The patient elected to keep the other tooth which is a wisdom tooth. Since the tooth is relatively stable with good bone support, it could be used to help stabilize the denture. After a few months of healing, Locators were attached to the implants for future denture engagement.
5 Sinus lift bone grafts and four implants in place
With the Locator attachment housings embedded in the denture in the precise locations and orientation, the denture can clip onto the Locators attached to the implants for resistance to falling during chewing, talking and smiling.
The patient is happy with the denture. Not just because the new denture can help him eat without fear of falling down, but it also makes his smile more pleasing as he shows his upper front teeth when he smiles naturally.
6 Four locators in the upper arch supported by four implants individually
7 The new upper denture with the locator attachment embedded in the denture
8 A more pleasant smile with the new denture in place
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Read some of our other blogs for more information on teeth implants, botox in dentistry, and more.
