Full Mouth Implant Rehabilitation for Generalised Periodontitis in a 63-Year-Old
Clinic | Enamel Dental, Hyderabad |
Patient Name | TVM Lakshmi |
Age | 63 years |
Gender | Female |
Location | Hyderabad |
Chief Complaint | Mobile and missing teeth |
Diagnostic Method | CBCT (Cone Beam Computed Tomography) |
Diagnosis | Generalised Periodontitis |
Treatment | All-on-6 Full Mouth Implants (Both Arches) |
Aesthetic Outcome | Excellent |
Functional Outcome | Good |
Healing Response | Satisfactory |
Patient Background
TVM Lakshmi, a 63-year-old female patient from Hyderabad, presented to Enamel Dental seeking a permanent solution for extensively mobile and missing teeth. Years of unmanaged generalised periodontitis had left her dentition severely compromised, and she was no longer able to rely on her remaining teeth for routine chewing or confident social interaction. Following a thorough clinical assessment and CBCT imaging, leading implantologist in Banjara Hills Dr. Namratha Chandrahari recommended rehabilitation using the All-on-6 protocol, delivering six implants per arch to support a fixed, full-arch zirconia prosthesis across both jaws.
For a patient of Lakshmi’s age and periodontal history, a fixed implant-supported prosthesis offered a predictable long-term outcome that removable dentures simply could not match. The plan was designed to address the complete picture: clear the failing dentition, restore both arches in a single coordinated procedure, and deliver stable full mouth dental implants that would hold up under full occlusal load without further dependence on periodontally compromised teeth.
Before and after — frontal portrait showing smile transformation following All-on-6 full mouth implant rehabilitation
Presenting Symptoms
The clinical picture documented at Lakshmi’s first consultation reflected the cumulative effect of longstanding, generalised periodontal disease across both arches:
- Mobile teeth across multiple quadrants, with several units no longer capable of bearing functional load, leaving Lakshmi unable to chew firmer foods.
- Multiple missing teeth creating posterior and anterior gaps that had altered her bite pattern and shifted chewing load onto the remaining natural teeth.
- Generalised periodontitis with bone loss evident across both the upper and lower arches on CBCT imaging.
- Reduced chewing efficiency, with Lakshmi relying on a self-restricted soft diet to manage day to day.
- Aesthetic concerns related to visible gaps and deteriorating dentition. A smile makeover was part of the rehabilitation goal alongside full functional restoration.
- Psychological impact of longstanding dental instability, affecting confidence in social and professional settings.
Before and after — 3/4 angle view showing restored facial harmony and confident smile after All-on-6 rehabilitation
Before and after — side profile view showing smile transformation following All-on-6 rehabilitation
Diagnostic Method
A full clinical examination was conducted to assess the periodontal status of all remaining teeth, the degree of bone loss, and the overall architecture of both arches. Gum inflammation, probing depths, and tooth mobility were documented at each site to build a complete baseline picture.
A CBCT (Cone Beam Computed Tomography) scan was then taken to construct a three-dimensional image of available bone across both jaws. The scan measured bone height, width, and density at each proposed implant site, mapped proximity to critical anatomical structures including the maxillary sinus floor and inferior alveolar canal, and confirmed where implant angulation would be needed to make use of available native bone without augmentation procedures.
This level of preoperative imaging is what separates precise, predictable implant placement from guesswork. In a full arch case involving twelve implant positions across two jaws, CBCT data is the foundation on which surgical sequencing, implant selection, and prosthetic planning are built.
Diagnosis
Clinical and radiographic findings confirmed a diagnosis of generalised periodontitis with extensive bone loss across both arches, multiple mobile teeth with a poor long-term prognosis, and significant edentulous gaps in posterior and anterior segments. The overall state of the dentition indicated that preserving the remaining natural teeth was not a viable long-term strategy. Full mouth implant rehabilitation using the All-on-6 protocol was confirmed as the most appropriate treatment approach for restoring function, aesthetics, and stability across both jaws.
Treatment Plan
A comprehensive full mouth implant rehabilitation plan was developed for both arches, integrating full mouth reconstruction principles to bring implants, prosthetics, and residual anatomy into one functioning bite. The plan was structured across the following clinical steps:
- Preoperative CBCT planning and surgical mapping across all implant sites in the upper jaw and lower jaw, identifying bone volume, angulation requirements, and implant depth at each position.
- Full mouth extraction of all failing and non-restorable teeth, clearing both arches for implant surgery.
- Placement of six implants per arch using the All-on-6 protocol, with posterior implants angulated where required to maximise engagement with native bone. This approach was selected over All-on-4 because the additional two implants per arch distribute occlusal load more evenly, which is particularly relevant for a full-arch bite carrying posterior loading across all positions.
- Where native bone anatomy allowed, posterior angulation eliminated the need for adjunctive procedures, following the same principle applied in implants without bone graft
- Placement of a provisional full-arch prosthesis on the day of surgery, restoring function and aesthetics during the osseointegration period.
- Structured healing and monitoring period to confirm stable implant integration before the definitive prosthesis was placed.
- Fabrication and fitting of the final full-arch zirconia prosthesis on both arches once integration was confirmed.
Surgical Procedure
All surgical work was carried out under local anaesthesia with strict aseptic protocol maintained throughout. Full mouth extractions were completed first and the sites were assessed against the CBCT plan before implant placement proceeded. Where socket conditions supported it, immediate implants were placed on the same day as extraction, reducing the overall treatment timeline and avoiding a separate second surgical visit.
Intraoral view — upper arch implant abutments post-placement (top) and lower arch provisional prosthesis seated on the day of surgery (bottom)
Six implants were placed in the upper arch and six in the lower arch at the CBCT-planned positions. Posterior implants were angled to maximise engagement with available native bone and to achieve the primary stability required for reliable osseointegration. Implant depth, spacing, and axial alignment were verified at each site before closure, with periapical X-rays taken intraoperatively to confirm position and depth in real time.
Custom-fabricated lower arch full-arch zirconia prosthesis — lab view before seating
Lower arch zirconia prosthesis — lab view displaying precise arch form, natural surface texture, and gum-line detail
Once osseointegration was confirmed across all twelve sites, the final zirconia prostheses were fabricated to precise specifications. Each arch was milled as a full-arch screw-retained unit with gum-coloured tissue simulation, designed to replicate the contour and colour of natural teeth and gingival tissue.
Custom-fabricated upper arch full-arch zirconia prosthesis — lab view showing tissue simulation and screw access channel
Upper arch zirconia prosthesis — frontal lab view showing gum-coloured tissue simulation, natural tooth proportion, and screw access channel
A provisional full-arch prosthesis was seated on the day of surgery, so Lakshmi left the clinic with a functioning, aesthetic set of teeth. The provisional was designed to be in slight under-occlusion during the healing phase, reducing load on the implants while osseointegration progressed.
Post-Surgery Care and Guidelines
The goal of post-operative care in an All-on-6 case is to protect osseointegration while the patient begins adjusting to their permanent teeth. Dr. Namratha Chandrahari issued detailed instructions covering the following:
- Oral hygiene protocol: Gentle cleaning around the provisional prosthesis from day two, using a soft-bristled brush and prescribed antiseptic rinses for the first two weeks.
- Dietary guidelines: A strictly soft diet for six to eight weeks, with firmer foods reintroduced only after review and confirmation of adequate healing at the implant sites.
- Medication compliance: Full course of prescribed antibiotics to reduce infection risk, with pain relief as needed during the acute post-operative period.
- Behavioural restrictions: Smoking and alcohol to be avoided during the entire healing phase, given their documented negative impact on osseointegration success rates.
- Prosthesis care: Instructions on cleaning under and around the provisional prosthesis, including use of interdental brushes and a water flosser to keep the implant-gum interface free of debris.
- Follow-up schedule: Review appointments planned at six weeks, three months, and six months to assess healing, monitor integration, and prepare for the final prosthesis fitting.
Outcomes & Results
The treatment outcome for TVM Lakshmi was documented across three dimensions at her final review:
Intraoral view — twelve implant abutments across both arches (top) and final full-arch zirconia prostheses seated (bottom)
Intraoral view — All-on-6 implant abutments across both arches (top) and final full-arch zirconia prostheses seated in occlusion (bottom)
Aesthetic outcome: Excellent. The final zirconia prosthesis delivered a full smile with natural tooth proportions, consistent colour, and symmetrical arch form across both jaws. The transformation was clinically significant given the extent of the presenting deterioration.
- Functional outcome: Good. Biting and chewing function was restored across both arches, with even occlusal load distribution confirmed at the final bite assessment. Lakshmi was able to return to a normal diet without the soft-food restrictions that had constrained her for years.
- Healing response: Satisfactory. Implant integration was confirmed across all twelve sites at review, with healthy peri-implant tissue, stable bone levels, and no complications through the monitoring period.
Intraoral view — upper arch implant abutments confirmed at review (top) and lower arch provisional prosthesis showing seated position (bottom)
Before and after — lateral face view. Restored lip support and confident smile following full mouth implant rehabilitation
Overall, the clinical assessment recorded a successful full mouth implant rehabilitation, with all three outcome parameters within the expected range for a patient of this age and periodontal history.
Long-Term Expectations
With consistent oral hygiene and the recommended review schedule, the long-term outlook for Lakshmi’s All-on-6 implants is good. For personalised guidance on ongoing care, Lakshmi can continue working with the best implantologist in Hyderabad, Dr. Namratha Chandrahari, through Enamel Dental’s structured recall programme.
The fixed zirconia prosthesis is designed to bear full biting load over many years without the bone resorption that removable dentures accelerate. Twice-yearly professional cleaning around the implant-prosthesis margins, combined with annual bite and bone-level monitoring, will help detect any early changes and maintain the integrity of the restoration over time. Patients who have undergone full mouth implant rehabilitation following generalised periodontitis achieve the best long-term results when they maintain the cleaning discipline established during the post-operative phase.
Before and after — 3/4 lateral view. Improved facial support and confident open smile following All-on-6 full mouth implant rehabilitation at Enamel Dental, Hyderabad
Before and after — frontal view. From a guarded, closed-lip expression to a full, confident smile following All-on-6 full mouth implant rehabilitation at Enamel Dental, Hyderabad
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