Dentist: Matthew Higginson
Location: The Implant Clinic at The Gardens Dental Practice, Dorchester, Dorset
Patient: Female with Dentinogenesis Imperfecta and failing dentition
A 48-year-old female patient presented with a complex history of deteriorating dentition associated with Dentinogenesis Imperfecta, a hereditary condition affecting dentine formation. Although she had attended another practice regularly, she was increasingly aware that her teeth were failing and no longer provided a reliable long term solution.
Her primary objective was to achieve a stable, fixed outcome that would allow her to eat comfortably and restore confidence in her smile.
Dentinogenesis Imperfecta commonly presents with discoloured, translucent teeth with reduced structural integrity. While enamel formation may initially appear normal, it fractures easily due to inadequate dentine support. Radiographic assessment typically reveals bulbous crowns, shortened roots, and early obliteration of the pulp chambers, all of which were evident on the patient’s pre-treatment OPG.
At presentation, the patient had lost all upper dentition and was wearing a full acrylic denture. She reported dissatisfaction with the prosthesis due to poor stability, limited retention, reduced comfort, and compromised aesthetics.
The lower dentition was also significantly compromised, with minimal posterior support, a heavily worn molar on the left side, previously restored premolars, and moderate to severe tooth surface loss affecting the anterior teeth. Overall, the remaining dentition presented a poor long term prognosis.
Treatment alternatives
A range of treatment options was discussed for both the upper and lower arches.
Upper arch
- Replacement acrylic denture
- Implant retained overdenture (Novaloc or bar retained)
- Implant retained fixed full arch bridge
Lower arch
Retention of the remaining dentition through further restorative treatment, including crowns, with replacement of missing teeth using a cobalt-chrome removable prosthesis or implant-supported restorations, was also considered. However, due to short roots and compromised dentine, the long term prognosis remained poor.
- Full clearance of the lower arch followed by:
- Acrylic denture
- Implant retained overdenture (Novaloc or bar retained)
- Implant retained fixed full arch bridge
The patient expressed a clear preference for removal of the remaining dentition. She did not wish to proceed with any removable solution, including implant retained overdentures, and opted for implant retained fixed full arch bridges in both arches.
Digital planning and workflow
Quoris3D planned the case using a fully digital, restorative driven approach. Planning was completed from the intended final outcome, ensuring implant positioning, bone reduction, and restorative space were optimised to support both function and aesthetics.
The final plan included five implants in the upper arch and four in the lower arch. Implant angulation was carefully controlled to avoid anatomical structures while achieving optimal distribution and long term stability.
Upper arch planning
Implants were positioned within the planned prosthetic envelope to support appropriate emergence profile, screw access, and aesthetic integration, while maintaining adequate bone support.
Lower arch planning
Implant placement was designed to maximise anteroposterior spread and support a full contour zirconia restoration, ensuring sufficient restorative thickness and structural integrity.
Guided surgery and immediate conversion
Both arches were treated during a single surgical appointment under local anaesthetic. Guided surgery enabled accurate implant placement in line with the digital plan, with all implants achieving strong primary stability.
Bone reduction and implant placement were carried out efficiently using the guided protocol. Multi-unit abutments were placed as planned, and immediate provisional restorations were delivered chairside.
Following placement of the provisionals, the patient was guided into a centralised occlusal position. Minor adjustments were made to establish a protective occlusal scheme with light centric contacts and minimal lateral loading.
A post-operative OPG confirmed passive seating of the prostheses.
Outcome
Healing progressed without complication, and the patient adapted well to the new occlusal relationship. Early function improved significantly, with increased comfort and stability from the provisional restorations.
Final restorations
After a four month healing period, final records were taken using the provisional restorations as a reference to maintain continuity and accuracy. The patient requested a minor refinement to tooth position and selected a final shade of A1.
The definitive restorations were delivered four weeks later. The prostheses seated passively with minimal adjustment required, reflecting the accuracy of the digital planning and guided workflow.
Occlusion was stable, aesthetics were natural, and phonetics were well balanced. The final outcome provided a predictable and functional solution with a high level of patient satisfaction.
The patient reported a significant improvement in confidence and quality of life and was extremely pleased with the result.
Matthew Higginson’s review and reflections
“ The CHROME GuidedSMILE workflow provides a structured and reliable approach to full arch rehabilitation, supporting both efficiency and clinical control throughout treatment. By planning from the intended restorative outcome, implant placement can be optimised to support the final prostheses, reducing intraoperative adjustments and improving overall predictability.
The integration of digital planning, guided surgery, and immediate provisionalisation enables a streamlined workflow, particularly in complex cases where conventional approaches may offer limited predictability. This approach allows consistent outcomes to be achieved while maintaining a high standard of documentation, supporting both clinical governance and long term treatment success.
