In dealing with the failing/failed dentition like this case, a dentist must ask himself question; Where do we start from?
First, extra- and intra-oral photographs, X-rays and pre-treatment record e.g. study casts. 
Extra-oral photographs are very helpful in patients’ smile analysis. Taking pictures of the patient at rest position, normal smile and high smile to assess lip length, incisal length, smile line and anterior tooth display. Profile picture can tell protrusion of teeth, lips and jaws. Once all useful records have been taken, corrective phase of treatment can begin: extraction of all hopeless teeth! Provisional prostheses are then inserted immediately after teeth extraction. These immediate provisional dentures are fabricated based on patients’ natural teeth position and may require re-contouring or redone.
Once the provisional dentures are properly contoured, they can be used as radiographic and surgical templates.
Assessment of tooth size, smile line, anterior tooth display and incised length are the key to achieve the best aesthetic outcome of implant prostheses. Numbers, location and angulation of implants and prosthesis design must be verified at this stage. Accurate dental implant positioning with the respect of prosthetic/aesthetic-driven concept and biological limit of bony structure. In this case, bilateral sinus augmentation surgery were performed to increase bone height of posterior maxilla. Ideal implant positioning; location and angulation of dental implants is so important and a surgical template is a must to achieve this!. The key is “Begin with the End in Mind”!!
Integration time of dental implants is 3-6 months.
Pictures show final fixed ceramo-metal implant prostheses. Notice the ideal implant positioning according to a proper pre-surgical planning.
Ideal implant positioning allows implant practitioners to achieve the best aesthetic outcome. The final implant prostheses could reflect our well pre-surcial implant planning.
Post-operative photographs obviously show the differences of the patient’s smile. Optimal aesthetic result is achieved by improvement of tooth size, color, inclination, and anterior tooth display.
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