I had a full upper arch restoration. It did not turn out well. What are my options now?

Patient Question

Rachel Martinez 🇺🇸: Dr. Samuel, I recently had a full upper arch restoration procedure done that involved multiple implants and a fixed bridge. Unfortunately, I’m extremely unhappy with the results. The teeth look unnatural and too large, my bite feels off, I’m having trouble speaking clearly, and there’s constant discomfort. I’ve spoken to my original dentist multiple times, but the adjustments they’ve made haven’t helped. I’ve invested a significant amount of money in this, and I’m devastated by the outcome. What options do I have at this point for correcting these issues? Is it possible to salvage this situation or will I need to start over completely?

Dr. Rockson Samuel’s Response

Dr. Rockson Samuel: I’m truly sorry to hear about your experience, Rachel. A full upper arch restoration represents a significant investment—not just financially, but emotionally and physically as well. When the results fall short of expectations, it can be devastating. Let me assure you that there are typically options available for improving or correcting unsatisfactory outcomes, even in complex cases.

Understanding Your Current Situation

Before discussing specific options, it’s important to categorize the issues you’re experiencing:

1. Aesthetic Concerns:

   • The appearance of teeth looking unnatural and too large
   • This suggests potential issues with prosthesis design, material selection, or tooth proportions

2. Functional Problems:

   • Your bite feeling “off”
   • Speech difficulties
   • These indicate potential occlusal (bite relationship) issues, improper vertical dimension, or positioning problems

3. Comfort Issues:

   • Persistent discomfort
   • This could relate to pressure points, occlusal trauma, improper fitting, or adaptation challenges

The complexity of your situation lies in addressing all three areas simultaneously, as they’re often interconnected.

Evaluation Process for Revision Options

Your first step should be a comprehensive evaluation by a specialist, preferably a prosthodontist who has extensive experience with full-arch rehabilitation and implant restorations. This evaluation should include:

1. Comprehensive Records:

   • Full clinical examination of the current restoration
   • Complete series of intraoral and extraoral photographs
   • New radiographs including panoramic and periapical views
   • CBCT scan to evaluate implant positions and available bone
   • Mounted diagnostic casts for occlusal analysis
   • Functional movement recordings if possible

2. Implant Assessment:

   • Evaluation of implant integration and health
   • Assessment of implant positions and angulations
   • Determination if the current implants can support a revised restoration

3. Prosthetic Analysis:

   • Material and design evaluation of the current prosthesis
   • Framework fit and passive seating assessment
   • Occlusal scheme analysis

Potential Solution Pathways

Based on my experience with similar cases, here are the main options typically available:

Option 1: Modification of Existing Prosthesis

If the fundamental aspects of the restoration are sound (implants are well-integrated, basic framework is acceptable), modifications might include:

• Aesthetic Refinement:

  • Removing and replacing the outer porcelain/ceramic layer
  • Recontouring the facial aspects to improve appearance
  • Adjusting the size, shape, and proportion of teeth
  • Color modification or characterization

• Occlusal Adjustments:

  • Selective grinding to harmonize bite forces
  • Addition of material in specific areas to improve function
  • Adjustments to improve speech production

• Comfort Enhancement:

  • Relief of pressure points
  • Adjustment of tissue-bearing surfaces
  • Modification of emergence profiles

This approach is generally less costly and time-consuming than a complete redo, but has limitations in how much change can be achieved.

Option 2: Complete Revision with New Prosthesis

If the issues are fundamental or the current prosthesis cannot be adequately modified:

• Utilizing Existing Implants:

  • Fabricating an entirely new prosthesis on the current implants
  • This may involve different materials or design approach
  • Possibly changing from screw-retained to cement-retained (or vice versa)
  • Potentially utilizing different abutment systems

• Hybrid Approach:

  • Retaining some components (like the substructure)
  • Completely replacing others (like the veneering material)
  • This can be more cost-effective than total replacement

Option 3: Strategic Implant Addition/Replacement

In some cases, the implant positions themselves may contribute to the restoration’s shortcomings:

• Supplemental Implants:

  • Adding implants to improve support or allow better prosthetic design
  • This creates more options for the restoration’s configuration

• Removal and Replacement:

  • In rare cases, poorly positioned implants may need removal
  • New implants placed in more favorable positions
  • This is the most invasive and costly approach but sometimes necessary

Option 4: Phased Approach

For financial or practical reasons, corrections might be implemented in stages:

• Immediate Functional Corrections:

  • Addressing the most pressing occlusal and comfort issues first
  • Ensuring basic function and health are restored

• Secondary Aesthetic Improvements:

  • Proceeding to aesthetic enhancements once function is stabilized
  • This may involve provisionalization to test changes

Important Considerations

As you navigate this challenging situation, keep these points in mind:

1. Documentation Is Crucial:

   • Collect all records from your original treatment
   • Document all communication with your current provider
   • Take photographs of your current situation
   • Keep a journal of specific issues and symptoms

2. Second Opinions Are Valuable:

   • Consult with at least two specialists (prosthodontists) for perspective
   • University-based prosthodontic departments can offer excellent resources
   • Look for providers with specific experience in revising full-arch cases

3. Interdisciplinary Approach:

   • Complex revisions often benefit from multiple specialists
   • This might include prosthodontists, oral surgeons, and sometimes speech pathologists

4. Financial Considerations:

   • Discuss financial responsibility with your original provider
   • Explore warranty or guarantee provisions from the original treatment
   • Consider dental insurance coverage for functionally necessary corrections
   • Evaluate financing options for extensive revisions

5. Emotional Support:

   • Acknowledge the emotional impact of this experience
   • Set realistic expectations for the revision process
   • Understand that revisions often require patience and multiple adjustments

Specific Next Steps I Recommend

Based on what you’ve described, I suggest these immediate actions:

1. Seek a Prosthodontic Consultation:

   • Look for board-certified prosthodontists with experience in implant rehabilitation
   • Bring all available records from your original treatment
   • Be specific about your concerns and priorities

2. Objective Documentation:

   • Have comprehensive records made of your current situation
   • These will be valuable for planning and potentially for resolution with the original provider

3. Explore Resolution with Original Provider:

   • If not already attempted, formally document your concerns in writing
   • Propose specific remediation steps based on specialist consultations
   • Reference any warranties or guarantees provided

4. Develop a Prioritized Problem List:

   • Separate functional issues (which affect health) from aesthetic concerns
   • This helps create a logical sequence for addressing problems

I’d be happy to examine your specific case and provide more tailored recommendations. Full arch rehabilitations are complex, and revisions require careful planning and execution, but significant improvements are almost always possible with the right approach.

Further Reading and Resources

For more information on related topics, you might find these resources helpful:

• Dental Implants: Permanent Solution
• Smile Makeover: Comprehensive Guide
• Digital Smile Design: Modern Approach
• Seeking a Second Opinion in Complex Dental Cases