Full-mouth All-on-X rehabilitation (both arches): increased VDO, lip support and a straightened plane

Full-mouth All-on-X rehabilitation, both arches · Case study

A case about how much it matters to validate everything before the final work: VDO, lip support and the plane of the restoration, checked on the patient with a try-in of the printed setup.

Patient front view with the initial provisionals, photo aligned to the bipupillary line, with reference lines — Before

Patient smiling with the final prostheses, with facial reference lines — After

Situation

After wearing provisionals during the osseointegration period of the implants, the patient came to the clinic for the final prosthetic stage.

As the photos show, the provisionals made immediately after surgery were more or less acceptable, but the plane was slightly tilted relative to the bipupillary line, they did not give enough support to the lip, and the vertical dimension of occlusion (VDO) was too low. As a result, the patient looked like a very elderly person with major loss of bone support.

Decision

I talked with the prosthodontist and explained what concerned me: the aged appearance of the patient and the tilted plane. We agreed that I would increase the vertical dimension of occlusion (VDO) and compensate for the missing bone support, so that the lip would be well supported.

Last but not least, I straightened the plane using intraoral scans of the provisionals. We agreed to validate everything with a try-in of the printed setup of the design: occlusion, VDO, lip support and the plane of the restoration parallel to the bipupillary line, with intraoral scans and photos of the patient standing at the end of the try-in.

After the setup try-in we got the go-ahead to finish the work, but while analysing the photos I noticed a slight tilt of the plane, so I made the final adjustments based on those photos. Then I moved on to making the frameworks and the crowns and applying the pink composite gingiva layer.

Result

The final result showed that validating the setup try-ins was essential. The patient received the delivered prostheses very well, feeling as if they were his natural teeth, and the final aesthetic appearance was very good.

The patient was delighted, the dentist was also very satisfied with the delivered case, and I, as the technician, was happy with the final result too. All of this was possible thanks to good communication and collaboration between dentist and technician. The data I was given provided many elements that made the final result predictable.