All-on-6 Dental Implants: Managing Complete Edentulism with Dyskinesia at 85
Doctor’s Name:
Patient's Name
Rama Naidu
Chief Complaint
Dyskinesia with mandibular instability; conventional denture plan shifted to implant-supported rehabilitation
Diagnostic Method
CBCT (Cone Beam Computed Tomography)
Clinic Name
Enamel Dental Clinic, Banjara Hills, Hyderabad
Patient's Age
85 years
Gender
Male
Treatment
All-on-6 Full Mouth Dental Implants
Patient Background
Rama Naidu, a 85-year-old man from Hyderabad, presented to Enamel Dental Clinic in Banjara Hills with a case that required both clinical precision and careful treatment planning. He was completely edentulous across both arches, and his initial evaluation had led to a conventional denture-based rehabilitation plan. However, a concurrent diagnosis of dyskinesia introduced a significant complication. Dyskinesia involves involuntary muscle movements, and in Sambasiva’s case, it was causing persistent mandibular instability. This made it clinically impractical to place and retain conventional dentures with any reliability.
The involuntary jaw movements created a situation where a removable prosthesis could not achieve the stability needed for comfortable speech or chewing. Faced with this challenge, the treatment plan was reconsidered and shifted toward a fixed implant-supported solution. All-on-6 dental implants were identified as the most appropriate path forward, offering the fixed, bone-anchored support that a conventional denture simply could not provide in the presence of a movement disorder.
Presenting Symptoms
These presenting challenges made Rama Naidu’s case clinically complex, requiring a solution that could withstand involuntary jaw movement and deliver fixed, reliable function across both arches.
Complete edentulism: All teeth were absent across both the upper and lower arches, leaving no natural dentition to support any form of prosthesis.
Dyskinesia with mandibular instability: Involuntary, repetitive jaw movements resulted in constant positional shifts of the mandible, making reliable denture placement impossible.
Failed conventional denture plan: A removable denture had initially been considered but was ruled out due to the impossibility of achieving adequate retention in the presence of uncontrolled jaw movement.
Compromised masticatory function: The patient was unable to chew food effectively, severely restricting his diet and impacting daily nutrition.
Speech difficulty: The absence of fixed dental support, combined with mandibular instability, was affecting the clarity of speech and social confidence.
Reduced quality of life: The inability to eat comfortably, combined with the visible absence of teeth, was affecting his participation in family meals and social settings.
These ongoing concerns led Mr. Yadav to seek a definitive, long-term implant-based solution rather than another removable or fixed bridge that could fail again.
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Diagnostic Method
A thorough clinical examination was conducted to understand the extent of bone resorption across both arches and to assess the viability of implant placement. Given the complexity introduced by dyskinesia, accurate preoperative data was essential before any surgical decisions were finalised.
A CBCT (Cone Beam Computed Tomography) scan was taken to generate a three-dimensional map of both the maxilla and mandible. The scan provided detailed information on available bone height, bone width, bone density at each potential implant site, and the proximity of critical anatomical structures including the maxillary sinuses and inferior alveolar nerve. This level of imaging accuracy was non-negotiable in an All-on-6 case involving complete edentulism, where implant angulation and distribution carry the full load of the prosthesis with no remaining teeth for supplementary support.
The CBCT findings were used to plan precise implant positions and angulations, ensuring maximum primary stability from the available bone volume.
Diagnosis
Based on clinical examination and CBCT findings, Sambasiva Murthy was diagnosed with complete edentulism of both arches, with bone resorption characteristic of long-term tooth loss. The superimposed presence of dyskinesia with mandibular instability rendered any removable prosthetic option non-functional and clinically unreliable.
The diagnosis confirmed that a fixed, implant-anchored solution was the only viable treatment pathway. A full mouth rehabilitation approach using All-on-6 dental implants was selected for its ability to provide a stable, bone-integrated foundation that would not be displaced by involuntary jaw movements.
Treatment Plan
A comprehensive All-on-6 full mouth implant plan was developed across both arches, with the following staged approach:
- Bone assessment and surgical mapping: CBCT data was used to plot implant positions in both the maxilla and mandible, identifying zones of adequate bone volume and density for primary stability.
- Placement of six dental implants per arch: Both arches were planned for All-on-6 implant placement, with strategically angled posterior implants to maximise engagement in available bone without the need for bone grafting.
- Provisional fixed prosthesis: Temporary fixed prostheses were planned for immediate or early loading, to restore basic function and allow Sambasiva to adapt during the healing phase.
- Monitoring mandibular stability post-placement: Given the dyskinesia diagnosis, close post-operative monitoring was built into the plan to assess how the fixed prosthesis performed under conditions of involuntary jaw movement.
- Final All-on-6 fixed prosthesis: Following confirmed osseointegration, the final full-arch implant-supported bridges were placed, restoring complete masticatory function, speech support, and dental aesthetics across both jaws.
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Surgical Procedure
The surgical procedure was carried out under local anaesthesia with strict aseptic protocol. Both arches were treated in a planned sequence, beginning with a thorough assessment of the edentulous ridges at the time of surgery to confirm consistency with the preoperative CBCT data.
Six dental implants were placed in the maxilla, followed by the mandible, using CBCT-guided angulations. The posterior implants were tilted to engage denser, more posterior bone, following the core biomechanical principle of the All-on-6 design. This tilt strategy increased the anteroposterior spread of the implant base, improving load distribution and resistance to the lateral forces that are particularly relevant in a patient with dyskinesia.
Primary stability was confirmed at each implant site before abutments were placed. A provisional fixed bridge was secured to both arches, giving Rama Naidu immediately functional, fixed teeth on the day of treatment.
Post-Surgery Care and Guidelines
Detailed post-operative instructions were provided to support healing and protect the newly placed implants:
- Oral hygiene protocol: Gentle brushing with a soft-bristled toothbrush from day two, antiseptic mouthwash rinses, and water flosser use around the prosthesis once initial healing was confirmed.
- Dietary guidelines: A soft diet was to be maintained during the initial healing weeks, with gradual reintroduction of firmer foods as osseointegration progressed.
- Medications: Prescribed antibiotics and analgesics were to be completed as directed. Anti-inflammatory medication was recommended to manage initial post-surgical swelling.
- Activity and habits: Rest was advised for the first 48 hours. Smoking, alcohol consumption, and any activity that could stress the provisional prosthesis were strictly discouraged.
- Managing dyskinesia during recovery: Additional monitoring appointments were scheduled at closer intervals to check for any undue stress on the implants from involuntary jaw movement.
- Follow-up schedule: Regular review visits were planned to monitor osseointegration, assess peri-implant tissue health, and verify the fit and integrity of both the provisional and final prostheses.
Outcomes & Results
The treatment outcome for Rama Naidu was satisfactory. Both All-on-6 implant-supported prostheses showed stable osseointegration at follow-up, with healthy peri-implant tissue and even load distribution across both arches. The fixed nature of the implant-supported bridges successfully eliminated the displacement problem that had made conventional dentures unsuitable for this patient.
Masticatory function was restored to a clinically acceptable standard, with Rama able to eat a regular diet without discomfort or prosthesis instability. Despite the underlying dyskinesia, the bone-anchored implants maintained their position without signs of loosening or adverse loading at review appointments.
The clinical assessment, overseen by Dr. Namratha Chandrahari, recorded a satisfactory functional outcome with good prognosis for long-term implant survival, provided ongoing oral hygiene and periodic monitoring are maintained.
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Long-Term Expectations
The long-term outlook for Sambasiva Murthy is good, provided that the underlying dyskinesia remains managed and that regular dental review appointments are maintained. The All-on-6 implants function as artificial roots in both jaws, stimulating the underlying bone and preventing the progressive resorption that typically accelerates in completely edentulous patients.
Periodic professional cleaning around the implant-prosthesis interface, along with six-monthly clinical reviews, will be essential for protecting peri-implant tissue health and detecting any early signs of mechanical stress from the jaw movement disorder.
Patient Feedback
Rama Naidu shared his experience following the completion of treatment:
“I had no teeth and the doctors first told me dentures might work, but they were not fitting because of my jaw problem. When Dr. Namratha explained the implant option, I was not sure, but I went ahead. Now both my jaws have fixed teeth, I can eat properly, and the teeth do not move even with my jaw condition. I feel much better than I did before and I wish I had come here sooner.”
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