Skeletal Reduction and Full-Arch Prosthetic Rehabilitation

21st Feb. 2026

Skeletal Reduction and Full-Arch Prosthetic Rehabilitation

Skeletal Reduction and Full-Arch Prosthetic Rehabilitation with FP3 Implant Bridge and Maxillary Complete Denture

 Dr. Arman Barfeie – Specialist in Prosthodontics

The case attracted widespread professional interest and was widely shared among the dental community.

Clinical Background

This patient was a highly self-conscious and emotionally distressed patient, presented with a severely compromised smile she had struggled with for years. She had previously undergone various restorative procedures, inc

Clinically, she displayed a severe gummy smile, an imbalanced occlusal relationship, and significant skeletal discrepancies. The upper anterior teeth appeared disproportionately small within the facial frame, and her occlusion was characterised by a Class II division 1 pattern with excessive overjet, traumatic bite, and vertical disharmony.

Outcome

This case resulted in a dramatic transformation both functionally and emotionally. Our patient regained a confident smile, improved occlusal stability, and a harmonious facial profile. The prosthetic plan—removable in the upper arch and fixed in the lower—balanced patient comfort, hygiene access, and long-term function.

Her previously “gummy” smile was corrected through a combination of skeletal and prosthetic modification, resulting in a natural, proportionate smile line.

The case highlights how careful skeletal planning, vertical correction, and prosthetically guided implant placement can be leveraged to rehabilitate patients with severe dentofacial compromise. Paulette’s outcome stands as a testament to interdisciplinary planning and patient-centred care.

How we did it…..

Diagnosis and Treatment Plan

A dual-arch rehabilitation was indicated, combining surgical intervention, vertical dimension correction, and prosthetic reconstruction to address Paulette’s functional and aesthetic needs.

Maxillary Arch

• Paulette’s upper jaw exhibited excessive vertical maxillary height, contributing to gingival overexposure and aesthetically imbalanced.
• We carried out alveolar reduction surgery (osteoplasty) to reduce the vertical bony and gingival display, repositioning the prosthetic envelope within an ideal aesthetic pla
• A complete maxillary denture was selected to provide optimal lip support, smile design control, and prosthetic flexibility in the context of reduced bony support and previous restorative failures.

Mandibular Arch

The lower jaw showed significant resorption, a failing occlusion, and limited restorative space. A fixed solution was preferred given the patient’s functional goals and dislike of removable prostheses in the mandible.

• Following site development and careful angulation planning, four dental implants were placed in a strategic distribution to support a fixed FP3 zirconia bridge.
• An FP3 prosthesis was chosen as it replaces both the crowns and soft tissue volume, ideal for cases with vertical ridge deficiency and the need for aesthetic tissue replacement.

Occlusal Rehabilitation

• The vertical dimension of occlusion (VDO) was intentionally increased to manage the traumatic bite, improve incisal relationship, and restore facial proportions.
• The treatment aimed to achieve a Class I incisal relationship, transforming the previously protrusive, dysfunctional occlusion into a stable and aesthetic anterior-posterior relationship.

Materials and Techniques Used

• Surgical
  • Alveolar osteoplasty of the maxilla
• Prosthetic
  • Maxilla: Full upper denture
  • Mandible: FP3 monolithic zirconia bridge on four implants
• Technology
  • Photogrammetry for accurate implant position transfer
  • iTero intraoral scanning for digital workflow
  • 3D treatment planning and design for surgical and prosthetic integration

Discussion

This case demonstrates the profound impact that integrated surgical-prosthetic planning can have on both the functional and emotional wellbeing of a patient. Paulette’s rehabilitation addressed not only the biomechanical challenges of occlusal instability and skeletal discrepancy, but also the psychosocial distress associated with her smile aesthetics.

The decision to use a removable maxillary prosthesis alongside a fixed mandibular FP3 restoration was a deliberate one—balancing prosthetic feasibility with patient preference and long-term maintenance. While lower dentures are often poorly tolerated due to tongue interference and instability, fixed solutions can significantly improve comfort and function. Conversely, the maxilla allowed for a well-retained denture with excellent aesthetic control, especially following alveolar reduction.

Importantly, this case illustrates the value of vertical dimension correction and alveolar osteoplasty in reshaping the prosthetic envelope and repositioning the smile line. By controlling these parameters surgically and prosthetically, we were able to eliminate the excessive gingival display and restore a natural, proportional smile.

Ultimately, Paulette’s case highlights the importance of patient-centred treatment planning and interdisciplinary collaboration. A prosthetically driven approach, combined with soft and hard tissue surgery, allowed us to transform a high-anxiety, high-complexity presentation into a predictable, functional, and aesthetic outcome.