Patient Profile: Patient is a 61-year old man with a failing dentition. He has struggled with dental treatment all his life and has dental anxiety. 

Chief Complaint: “I am unable to eat now that I have lost some key teeth, I do not want to wear dentures, I want teeth that are permanent in my mouth”.

Dental History: Infrequent dental attender and usually attends in pain to have a dental extraction. His dentist has discussed dentures and he is adamant he will not consider this option. 

Medical History: The patient reported he is medicated on an anti-hypertensive, statin and nu-seal aspirin. Bloods are all normal. His blood pressure was recorded at 143/92 mm/hg.

Extraoral Examination:

• Assessment reported over closed jaw relationship with no lip support. 

Supplemental Information:

• Upper arch has some over-erupted teeth with tooth decay and favourable bone levels. 
• Lower arch has some remaining teeth with limited function and an unerupted lingual canine.
• There is no functional and stable occlusion. 
• The upper arch had a maxillary clearance with six Nobel Biocare implants placed under local anaesthesia with IV sedation.
• The upper arch had grafting at the time of implant placement using autogenous bone, Ceros and Platelet Rich Growth Factors (PRGF). 
• The lower arch had surgical extraction of the buried canine and grafting with PRGF and Ceros.
• Six months later teeth were extracted and for implants were placed in the interforaminal region. 
• Both arches were restored with fixed screw retained hybrid dental implant bridges.