CASE 10 - Full upper and lower beam prosthesis

Mrs K from Marton born 1934

Mrs K attended CDIC having lost so much bone following almost a life time of having no natural teeth that it was virtually impossible for her to wear full upper and lower dentures. She reported having to eat only soft or mashed foods due to the pain she experienced from the dentures pressing onto her very thin gums. Initial examination showed there to be sufficient bone for a high level full beam restoration of the lower jaw but that there was insufficient bone to treat her upper jaw in any way.

Mrs K was referred to Mr Jones in Derby for bone augmentation in her upper jaw that provided sufficient bone volume to allow the placement of six fixtures. She also received five fixtures in her lower jaw. Due to the massive loss of hard and soft tissue following the original tooth loss is was not possible to create teeth that appeared as if they came straight out of the gum. It was necessary to construct a prosthesis that replaced both the missing teeth and the missing bone and soft tissue i.e. it had the pink gums on that are normally associated with a denture. To aid cleaning this type of prosthesis is kept away from the pt's own gums and hence its name of a "high level prosthesis". When viewed with the lips pulled right back this looks unwearable but once the lips are allowed to fall back into place all the metal is hidden and Mrs K looks as though she has a perfectly natural set of teeth. As these teeth are fixed firmly into her jaw and kept away from her fragile gums she is now able to eat anything she wants with out fear of pain or discomfort.

The high level prosthesis that looks unacceptable.	The same high level prosthesis that looks perfectly natural.

When wearing a normal denture the positioning of the teeth is dependent on how retentive the denture is. On many occasions patients need their teeth to be placed further forwards to give correct support to their lips and so create a better facial profile, but this is not possible in most cases as in this position the denture is un-retentive. A major advantage of having dental implants is that, as can be seen from the photographs of the biting surfaces of Mrs K's dentures, the teeth are much further forward than the holes where the denture is attached to the jaw. These holes show the position of where the teeth would have to be placed if implants were not used and Mrs K, as she did when she first attended CDIC, would have a very sunken facail appearance.

The light coloured circles in the pink acrylic, behind the teeth, show where the screw access holes are.

The cost of Mrs K’s treatment if it had been carried out today would be £18,500 for the implant treatment and between £3500 and £5000 for the bone graft.