There are certain cases in which the difficulty does not lie in weak bone or periodontal problems, but rather in their direct impact on facial appearance and harmony. This case is considered one of the most complex cases, where the main challenge was dealing with facial aesthetics before any other considerations.
Case Description
The patient was suffering from the loss of most, or almost all, of his teeth, with only two teeth remaining in the lower jaw. Upon clinical examination, a severe and clearly visible gummy smile was observed, which caused significant discomfort for the patient when smiling.
Based on radiographic examinations, several overlapping problems were identified, including:
- Class III malocclusion
- Reverse overjet exceeding 9 mm
- Marked protrusion of the mandible compared to the maxilla
- Irregular mandibular bone level, tilted forward and upward
- Presence of a fatty cyst in the maxilla
The combination of these factors made the case extremely complex and required meticulous planning before initiating any treatment procedure.
Diagnosis and Proposed Solution
From a medical standpoint, the ideal solution for such cases is orthognathic surgery, which is a major and complex surgical procedure. However, the patient completely رفض this option.
The patient had previously undergone treatment with prosthetic restorations that maintained a Class III occlusion, but the outcome was unsuccessful. He suffered from speech difficulties and weak chewing ability, which made him insist on achieving a stable, first-class occlusion without a reverse bite.
Case Planning
Planning was one of the most critical stages of this case, as it required a long period of time and significant effort before reaching the final treatment decision. The planning process relied on:
- Performing a facial scan to accurately analyze facial features
- Creating a digital mock-up to preview the expected occlusion before starting treatment
- Digital smile design that considers harmony between teeth, lips, and facial shape
From the treatment team’s perspective, this stage was the key factor in the success of the case.
Treatment Plan
A treatment solution was selected based on an implant-supported overdenture fixed on a bar, which is considered one of the most advanced and effective solutions for cases with increased vertical dimension and complex occlusal relationships.
Treatment Execution Steps
- Implant placement based on prior digital planning
- Designing a titanium bar to connect the implants and distribute forces evenly
- Using a locator system over the bar in both the maxilla and mandible to ensure stability and comfort
Relying solely on locator or magnet systems was not possible due to the large vertical dimension present in this case.
Outstanding Results
The treatment plan resulted in highly satisfactory functional and esthetic outcomes:
- Achieving stable and comfortable occlusion
- Clear improvement in facial appearance and harmony
- Restoration of the lips to their natural position after being retruded
- Significant improvement in speech ability and chewing strength
The patient has been followed up for approximately one and a half years, with regular dental visits every six months. He reports a high level of satisfaction with the final result, particularly due to the ease of removing, cleaning, and reinserting the prosthesis without difficulty.
The challenge in this case was not merely replacing missing teeth, but transforming a highly complex condition into a functionally and esthetically stable case without resorting to major orthognathic surgeries—achieved through precise planning and appropriate treatment solutions.
We share cases that represent real challenges in the field of dental implants because they reflect clinical expertise and sound, evidence-based treatment planning.
If you have a similar case or any questions regarding dental implants, feel free to contact us, and we will be happy to provide all the details.