Full-Mouth Case: Upper All-on-4 with Lower Veneers, Crowns and Implants

Summary: A patient travelled from Phetchaburi province for a complete treatment plan instead of fixing one tooth at a time. The original plan was to keep as many natural teeth as possible. When the old dental work on the upper teeth was removed, fewer than two upper teeth were strong enough to keep, so the upper jaw was changed to All-on-4 together with the patient. In the lower jaw, the natural teeth that could be saved were kept and treated with veneers, crowns or implants depending on each position. After four months with temporary teeth, the final upper and lower teeth were made together.

Case at a glance

The patient’s concern

The patient had problems with many teeth and did not want to keep repairing one tooth after another. The goal was a single, complete plan for the whole mouth.

The first plan: keep natural teeth where possible

Dr. Nalat initially planned to keep as many natural teeth as possible and place implants only where they were needed, because a healthy natural tooth is worth keeping.

Why the upper jaw changed to All-on-4

Teeth that are covered by old crowns or bridges can only be fully assessed once that work is removed. When it was taken off, fewer than two upper teeth were strong enough to keep. Dr. Nalat discussed the options with the patient, and together they changed the upper plan to All-on-4: four implants supporting a fixed bridge for the whole upper arch. The patient used temporary teeth while the implants bonded with the bone.

Lower jaw: a different treatment for each tooth

• Veneers for teeth with good structure, to match colour and shape with the new upper teeth
• Crowns for teeth with little remaining tooth structure that needed extra strength
• Dental implants where teeth were missing or could not be saved

Treatment steps

1. Examination and CT scan: a full-mouth treatment plan was prepared.
2. Removal of old upper dental work: the real condition of the teeth was assessed and the plan was changed to All-on-4 with the patient.
3. Upper implant surgery with a surgical guide: temporary teeth were fitted for use during healing.
4. About 4 months of healing: the implants and the temporary teeth were assessed.
5. Final teeth, upper and lower together: the All-on-4 bridge, veneers, crowns and crowns on implants.

Why the final teeth were made at the same time

Making the upper and lower final teeth together let the team plan colour, shape and the bite between the jaws as one design. The temporary phase was also used to check chewing, speech and the smile before the final teeth were made. This does not mean every case must be done this way; it was the approach chosen for this patient.

Treatment team

Travelling for full-mouth treatment?

This patient travelled from another province in Thailand. If you are coming from abroad, a plan like this is usually organised around two stays in Bangkok: one for assessment, surgery and temporary teeth, and one for the final teeth after healing. Let the team know on LINE that you are travelling, so appointments can be planned around your trips.

Questions about full-mouth treatment

What is full-mouth rehabilitation?

It is a plan that treats the upper and lower teeth together. It may combine several treatments, such as implants, crowns and veneers, so that the bite, chewing and smile work as a whole.

Why can a treatment plan change during treatment?

Teeth under old crowns or bridges can only be fully assessed once that work is removed. The dentist explains the backup options at the start and discusses any change with the patient before going ahead.

Will I be without teeth while I wait?

No. In this case the patient used temporary teeth for about four months, and that time was used to check chewing, speech and the smile.

How much does All-on-4 cost?

See the dental implant cost page for All-on-4 prices by implant system and bridge material.

Photos shared with the patient’s permission. Treatment results and timelines vary from person to person.