Building the Foundation
Working closely with Dr. Thomas White, an oral and maxillofacial surgeon, and
the Aurum team, we developed a phased treatment plan. As is common with ectodermal dysplasia, Elan’s alveolar ridges were underdeveloped, making implant predictability uncertain. For Elan, it marked the beginning of a life experience previously unavailable to him. A full smile. Functional dentition. Confidence in social identity.
Onlay grafting procedures were completed first to build adequate bone volume. Healing timelines were extended intentionally to maximize graft maturation before implant placement was attempted.
When implants were ultimately placed, the outcome exceeded our expectations: Eight implants in the maxilla, five implants in the mandible. For the first time, fixed full-arch restorations became a viable reality rather than a hopeful projection.
A Restorative Reset — No References
As we transitioned into the prosthetic phase, we encountered a significant limitation. Elan had lost his denture. There were no prosthetic records to duplicate. No vertical dimension reference. No tooth position guide. No phonetic baseline. We were starting from zero.
For those reasons I initially went with an analog workflow. Traditional PVS impressions were taken, and analog master casts were created. Wax rims with verification jigs were fabricated to establish midline, occlusal plane, lip support, and vertical dimension. Only after we built these physical references could we initiate the digital restorative workflow. The analog workflow allowed me to establish physical reference points that I then scanned and transitioned to the AurumTek / Nexus workflow.
The Aurum Team then provided a 3-dimensional digital design of the provisional inlaid with the photographs of the face. Once the initial records were approved, Aurum fabricated the AurumTek prosthetic try-ins. These are not simple wax try-ins or short-term provisionals. They are structurally functional, digitally designed transitional prostheses intended to be worn in real life, not just evaluated in the chair.
For Elan, this phase carried weight far beyond esthetics. He had never
functioned with teeth before. From the first insertion, I wasn’t just evaluating
occlusion and phonetics, I was observing neurological and muscular adaptation.
How would he chew? How would his speech evolve? Would his musculature
fatigue? Would the vertical dimension feel overwhelming?
We inserted the AURUMTEK® prostheses and sent him home with them. That
decision was intentional. Chairside approval would have been meaningless for a
patient with no frame-of-reference. He needed time to experience his new
restoration, time to eat, speak, and function socially.
Early Functional Observations
At the first follow-up, several insights emerged.
FUNCTIONALLY:
- Mastication was surprisingly efficient
- No TMJ discomfort
- Vertical dimension was well tolerated
PHONETICALLY:
- Minor adaptation period
- Rapid improvement within weeks
NEUROMUSCULARLY:
- No signs of muscle fatigue
- Comfortable closure patterns developing
This validated that the structural design of the AurumTek prosthetics was sound.
But esthetics told a different story. When reviewing facial photographs and live smile dynamics, we noticed limited incisal display—particularly at rest. This was not immediately obvious at insertion. It only became clear after lip relaxation patterns normalized, speech movements stabilized and smiling became more natural rather than posed.
Because Elan had never had teeth, his lip posture lacked the muscular memory that typically guides esthetic setup. We determined that the occlusal plane needed to be lowered to increase incisal show and improve smile framing.
We revised the design digitally using updated facial photography and smile
analysis. A second AURUMTEK® set was fabricated with adjusted tooth position
and incisal length. Again, Elan wore them in daily life for several weeks. This
second adaptation period showed improved smile display and better lip
support while maintaining phonetics and stable function.
When he returned, his response—and his family’s—was immediate.
This was the first time they felt they were seeing his “real smile.”
Transitioning to Final Prosthetics
Given Elan’s age—22 at the time of delivery—material selection required long-term thinking. For the maxillary arch we chose Zirconia for it’s strength and esthetics.
For the mandibular arch, milled PMMA was chosen for resilience and serviceability.
The milled PMMA offered superior durability compared to traditional denture-tooth hybrids while preserving the ability to modify or maintain the prosthesis over time.
For a patient expected to function with these restorations for decades, that flexibility mattered.
Clinical Reflections
From a clinical standpoint, this case reinforced several principles for me:
• Developmental full-arch cases require longer adaptation windows.
Immediate finalization would have been premature.
• Try-ins must be lived in, not just viewed. Especially when patients
lack neuromuscular reference.
• Esthetics emerge after function stabilizes, not before.
• The AURUMTEK® process transformed uncertainty into confidence allowing me to verify decisions not just clinically, but behaviorally and emotionally before committing to final prosthetics.
The Patient Outcome
Delivering the final restorations was unlike any other full-arch delivery I’ve performed.
Elan wasn’t comparing the result to what he used to have. He was experiencing teeth—truly experiencing them—for the first time. We watched him smile differently.
Speak more freely. Carry facial support he’d never had.
Full-arch implant dentistry often focuses on replacing failing teeth. This case reframed its purpose. It demonstrated how structured workflows can support not just surgical success, but human adaptation, especially when the patient has no prior frame of reference.
For this provider, the case validated that even the most complex presentations can be navigated predictably with the right restorative framework.
For Elan, it marked the beginning of a life experience previously unavailable to him. A full smile. Functional dentition. Confidence in social identity.
This case represents what is possible when clinical expertise, advanced restorative workflows, and true collaboration come together in service of the patient. We extend our sincere thanks to Elan for his trust and commitment throughout this transformative journey, to Dr. Brad Bishop for his thoughtful, patient‑centred vision and clinical leadership, and to Dr. Thomas White for his surgical precision and partnership. It was a privilege to support a treatment that went beyond restoring teeth to restoring confidence, function, and quality of life.
Just Ask Dave
Curious how a case like this could translate to your own patients or practice?
Dave Costanzo, our Product Manager and All‑On‑X expert, works directly with clinicians to plan, problem‑solve, and simplify complex full‑arch restorations. Book a no‑obligation consultation with Dave to talk through your questions, workflows, and next steps—practical insight, no pressure.
