Insights · Dental Implants
She was told she would need a denture. She never wore one.
Advanced periodontal disease had left none of her upper teeth maintainable. Dr. Shay explains how a staged plan carried her to fixed implant restorations without a removable denture.
When she first came to see me, she was crying.
She already knew what was wrong. Advanced periodontal disease had damaged the bone supporting her upper teeth so severely that none of them could be saved long term. She had been told this years earlier, along with the proposed treatment: remove the teeth, wear a full denture while the bone healed and implants were placed, and eventually receive fixed implant restorations.
She had postponed treatment ever since.
Not because of the surgery. Because of the denture.
I understood why.
As a prosthodontist, I make dentures and appreciate what they can accomplish when they are the right treatment. I am also very aware of their limitations. A full upper denture covers the palate and rests on the gums. Learning to speak and eat with one can require a significant physical and emotional adjustment.
Her teeth could not be saved. But after examining her clinically and radiographically, I believed we could plan a different way through the transition.
Designing the smile first
Periodontal disease had caused her upper teeth to flare outward and shift from their natural positions. Before treatment began, I completed a diagnostic wax-up and designed a new smile around her facial features and proportions.
I considered the length and position of the teeth, how much tooth would show when she spoke and smiled, and how the new restoration would support her lips and lower face.
We established the intended result first, then used it to guide each phase of treatment.
A fixed transition
Four carefully selected teeth were retained temporarily. Although they were not part of the final treatment, they could support a fixed provisional restoration while the remaining teeth were removed and implants were placed in stages.
I prepared those teeth and fabricated a temporary smile designed to complement her face. Working in coordination with her implant surgeon, the hopeless teeth were then removed and implants were placed where the clinical conditions allowed.
The temporary restoration was supported by the retained teeth rather than resting on the surgical tissues or healing implants.
She left with fixed teeth.
Her treatment took approximately one year, but dental treatment did not take over her life. She remained very social and continued attending dinners without having to remove her teeth to eat. Her temporary smile looked so natural that she regularly received compliments. Many people assumed those teeth were already her final restorations.
That experience mattered. She could move through a complex treatment without feeling that everyone around her knew she was undergoing it.
From temporary teeth to the final restorations
Once the first implants had healed, the support for her fixed temporary restoration was transferred from the retained natural teeth to the implants. The final four teeth could then be removed and the remaining implants placed.
Her final treatment consisted of three implant-supported fixed partial dentures. Because periodontal disease had also caused the loss of bone and gum tissue, carefully layered pink porcelain was used to recreate the missing tissue, restore natural tooth proportions, and provide appropriate support for her lips and smile.
After I delivered the final restorations, she sent me a message saying that she loved her smile and was grateful.
The woman who had once sat in my office crying because she feared wearing a denture had completed her treatment without ever wearing one.
Is this possible for every patient?
No. This type of staged treatment depends on the condition and position of the remaining teeth, the available bone, implant stability, the patient’s bite and health, and how the tissues heal.
Some patients need a removable temporary restoration. Others may qualify for fixed temporary teeth on the day of implant placement. In selected cases like this one, retained teeth may support a fixed provisional restoration until the implants are ready to assume that role.
There is no single transition that is right for everyone. The diagnosis comes first, and the journey must be designed around the individual patient.
Good to Know
Frequently asked questions
In selected cases, yes. Fixed temporary teeth may sometimes be supported by retained natural teeth or implants while treatment progresses. An examination and appropriate imaging are necessary to determine whether this is possible.
It can. Staging the extractions and implant placement may extend treatment because each phase must heal before the next begins. This patient’s treatment took approximately one year, but timelines vary.
No. All-on-4 is one specific treatment concept. This was not an All-on-4 case; the patient received three implant-supported fixed partial dentures.
A prosthodontic evaluation considers your remaining teeth, bone, bite, health, facial support, and restorative goals. It should also address what you will wear and how you will function during treatment, not only the final result.
Sometimes the transition makes treatment possible
Many patients already know their teeth are failing. What keeps them from moving forward is fear of what will happen between losing those teeth and receiving their final restorations.
For this patient, changing the transition changed everything.
If you have postponed treatment because you are afraid of wearing a removable denture, you can begin by requesting a private consultation online. You do not need to describe your condition or include health information in the request. Our office can contact you privately to discuss the appropriate next step.
Individual results and treatment options vary. A clinical examination and appropriate imaging are required to determine candidacy.
