This patient I treated in Burbank, CA has no bone on the upper jaw. You can see that she was unable to wear a denture. Her face would cave in right to the bottom of the nose!!
I placed four zygomatic implants (quad zygoma) with a fixed bridge that she does not need to remove…ever. NO BONE GRAFTING WAS DONE!
I commonly focus on the profile trying to get the teeth into a vertical orientation. This helps decrease wrinkles and creases in the upper lip. If the teeth slant in they don’t look normal. This creates certain cantilever forces that connecting ( splinting) the implants together helps protect the bone.
Replacing your teeth when there is this amount of extreme bone loss requires a lot of testing with a temporary. These are made of PMMA. I often leave these in for 1-3 months to allow the patient to assess not only the teeth, but rather lip and face support.
Lip and face support considerations are really important for all on 4, Prettau, hybrid type full replacements. Keep in mind that these teeth are not just a tooth replacement but they are replacing tooth, the gum and bone.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry