A Blank Canvas
Problem: this patient sadly ended up with no teeth, losing them over a number of years. He was elderly and had lost the ability to eat even simple foods that he used to enjoy. He had the additional issue of a very strong gag reflex which required careful management. He was looking for a solution that very much reflected his senior years and honoured us with a carte blanche to create an extremely natural appearance for him. He was also smoker and made it clear that a 'Hollywood smile' would be the absolute opposite of how he envisaged his teeth to look.
Solution: since the patient had gone many years without any teeth whatsoever, we planned the reconstruction in two stages: firstly to provide a new set of complete dentures and if relevant, convert the prosthesis to implant retained as a second stage. This would allow plenty of time for adaptation to not only a new smile but for muscles to adapt and learn to chew more efficiently again.
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Discussion Points: the loss of teeth is truly disfiguring and negatively affects support for muscles and results in shrinkage of the underlying jaw bones. There is also the psychological impact of tooth loss to consider which can be significant. The facial structure and profile of these patients typically takes on a sunken appearance as was the case here. The greatest challenge in such cases is the lack of (anatomical) reference points, and effectively results in a blank canvas from which to rebuild the face back to what would be deemed ‘normal’ and age appropriate. Our patient who agreed to the bold artistic nuance, was delighted when presented with his new dentures and how realistic they looked in not only replacing teeth but also with respect to the gum detail which caught out more than a few unexpected observers (we acknowledge that for many patients such distinct ‘ageing’ characterisation of the prosthesis would not be to personal taste). His facial tissues were once more correctly supported giving him a fuller and healthy appearance overall.