Real Case: Immediate Load Implant Dentures! What Went Wrong (and How We Fixed It)
A Before and After of Mrs. Jones’ full mouth implant denture case at Teuscher Legacy Dental! See what went wrong, and how we fixed it. The entire case is in detail below!
A real, top and bottom full-arch implant denture case from St. Charles, IL
Patient: Mrs. Jones (not her real name)
Clinician: Teuscher Legacy Dental
Surgeon: Midwest Dental Implantology (our surgical partner)
Prosthetic system:
Temporary dentures: Acrylic
Bite and smile adjusted dentures: 3D Printed PMMA with custom glaze
Final dentures: Full-contour zirconia with titanium reinforcement (Rosen technique)
Dr Brayden Teuscher breaks down this immediate load implant denture case in detail!
The Situation: A Patient Frustrated that One Tooth After Another Kept Breaking
Full Face Smile - Before
Retracted view of all teeth - Before
Close up of smile - Before
Mrs. Jones has been a patient of ours in St Charles for years, but kept having one tooth after another break down and need dental work. She is a lovely lady, but frustrated with one tooth problem after another. Her whole life, her teeth had caused her trouble. It’s a situation we hear often! We discussed addressing her smile and bite in one fell swoop - the last restorative dentistry she’d ever need. We discussed some options, and showed her other real cases. In the end, she decided to go with a fresh slate: Full mouth extractions and implants. But she did not want to be without teeth to chew and smile.
The Goal: A Beautiful, Confident Smile - Now. Not Months From Now
Mrs. Jones needed full-arch extractions and immediate implants on both her upper and lower arches. The goal: leave the surgery with teeth to chew and smile with right away away (called immediate load), then refine fit, bite, and esthetics as the tissues heal. Ultimately finishing with a beautiful smile and comfortable bite. In this case “immediate loading” meant 24 hours after implant surgery was completed.
We coordinated with Midwest Dental Implantology for the surgery, and Ottawa Dental Lab for the dentures. This meant a lot of communication with the surgeon and lab on the front end, so that everything would run smoothly for Mrs Jones.
Key idea: With immediate loading, the first prosthesis gets you smiling and chewing right away. The final prosthesis is delivered after healing—when your bite and tissue positions are stable.
Bonus: More info on Implant Supported Denture types and comparison with traditional dentures!
What Went Exactly as Planned
The surgery itself. The teeth were extracted and implants placed. See the panoramic image below.
The new dentures fit perfectly onto the implants. A snug, perfect fit helps control and guide the healing process.
The shade and smile architecture of the new teeth. Mrs Jones was pleased with her new smile right away, and we all knew we may be able to improve it further in the final dentures.
We knew we’d have to make some adjustments to the denture bite! That is always the case with immediate dentures.
What Went “Wrong” (And Why That’s Normal)
Day-after delivery (first acrylic):
Smile looked great! Bruising present from surgery the previous day
Surgery went smoothly. All implants placed.
Immediate bite was slightly open in front and right sides!
Though the smile was great, Mrs. Jones’ right side bite was open. This meant, if she kept those denture teeth, she could not chew efficiently on that side during her healing process. We took a new scan immediately, and Ottawa Dental Lab remade the dentures for next-day delivery. She wore the existing ones home, and the next day we gave her an almost identical pair, with minor tweaks to make the bite just right.
Why did the open bite happen?
The day of surgery, the precise location of the dental implants was captured using Photogrammetry. Patients often assume that because implant dentistry now uses photogrammetry and digital scans, the bite should be “locked in” on day one with zero adjustments. The truth is: photogrammetry captures the precision of the implant positions, but not the biology of the soft tissues and muscles surrounding them.
| Reason | Simple Explanation |
|---|---|
| Swelling | Your gums and cheeks are puffy after surgery, so the bite does not close the same way yet. |
| Muscle Tension | Your jaw muscles are “protecting” the area, so you may not bite fully on one side. |
| New Bite Position | Your brain is learning a new bite, so it needs time to settle and feel natural. |
| Both Arches Done | With no “old” bite to guide it, small changes become noticeable as swelling changes. |
But shouldnt digital dentistry, with all the pre-planning be perfect?
| Concept | What It Really Means |
|---|---|
| Photogrammetry = Accuracy | The scan shows the exact implant positions, not swelling or muscle changes. |
| Healing = Change | Your body is shifting and relaxing during the first few days and weeks. |
| Not a “Mistake” | It’s normal for the bite to be adjusted once swelling goes down. |
Second day (second acrylic denture):
Bite was corrected and comfortable—she wore this during the 6-month healing phase. I did not have a good photo of this one. But the open bite was corrected, esthetics remained the same, and Mrs Jones was comfortable as she healed from the surgery. This temporary denture is very important for a couple reasons:
It allows full smile and comfortable chewing while the tissues heal
It test drives the esthetics of the new teeth and bite. In Mrs. Jones’ case, there were a few things we wanted to improve!
6 months later (After full healing):
We prepare the final smile. To do that right, we:
Raised the vertical dimension (slightly opening the bite) for facial support, youthful esthetics, and tooth display
3D-printed try-in dentures to test the new bite and smile design
New smile and bite filled cheeks better for more youthful facial appearance!
Close up of new smile teeth. They seemed bright.
Close up comparing standard shade B1 to teeth. These teeth are too bright for Mrs Jones!
Try-in issue:
The 3D-printed set was too bright—visibly brighter than a B1 shade tab. Mrs. Jones wanted a light shade than before, but both she and our clinical team agreed it crossed into the “too bright/unnatural” zone.
Our fix:
We custom glazed the 3D printed set to tone brightness and add natural characterization (micro-texture, slight incisal translucency, warmth at the necks). See how it compares to the B1 shade tab below in the before and after photos. She test-drove this new bite and esthetic for a few weeks. It felt right, looked right, and photographed beautifully for her at home.
Before Same-Day custom stain and glaze
After same-day custom stain and glaze to make shade slightly darker
Retracted view of full smile after same-day stain and glaze. This is much more natural looking in a temporary denture!
Bonus: Teuscher Legacy Dental was named “Best Cosmetic Dentist in St Charles, IL in 2025”. We do this type of cosmetic adjustment all the time, and win awards for it!
Final Denture:
We duplicated that approved design in full-contour zirconia with titanium reinforcement (Rosen technique) and delivered the definitive prostheses.
The Result:
Mrs. Jones was thrilled!
A Perfect, Beautiful Bite
Esthetic Zirconia Final Implant Dentures for the top and bottom
“Absolutely perfect.”
Mrs. Jones was thrilled. We called her to follow up a couple weeks after final delivery, and she told us she forgets she ever had it done. Her smile feels as natural as when she was in her 20’s!
Reminder: Why Immediate Load Can Need Tweaks
Post-op swelling shifts the bite (especially in the first 24–72 hours).
Soft tissue and muscle tone change through the healing period.
Implant occlusion (bite forces over the implants) needs precision to protect the implants long-term.
Shade perception changes in different lighting and with lip posture once swelling settles.
This is not failure—it’s quality control. The right approach is: diagnose early → correct promptly → prove the final design with a real-world test. It’s part of why implant supported dentures are more expensive than tissue supported at Teuscher Legacy Dental. We don’t nickel and dime you for every little thing. There is one fee for us to get the job done correctly. Always transparency, nothing hidden!
Why We Increased Her Vertical Dimension (VDO)
Patients ask: “Why change my bite height if the temporary was ‘fine’?”
Because the final smile should support the lips, soften lines, and show the right amount of teeth—without overloading the implants. See more in the table below.
Why We Increased the Vertical Dimension (VDO)
| Benefit | What the Patient Notices | Clinical Rationale (Simple) |
|---|---|---|
| Smoother lines around the mouth | Less folding or “collapse” of the corners of the lips | More facial support from the restored bite height |
| Fuller, more youthful smile | Teeth show properly when smiling and at rest | Proper incisal display improves facial proportions |
| Balanced chewing | Bite feels more even and stable | Vertical dimension protects implants from overload |
| Clearer speech | “S,” “F,” and “V” sounds feel natural again | Tooth position and speaking space improve with correct VDO |
| Better long-term durability | Final teeth feel stable and built to last | Balanced forces reduce wear and implant stress |
Notes for clinicians reading: Classic prosth literature supports evaluating/restoring VDO for esthetics, phonetics, and function (e.g., Turner & Missirlian 1984; Silverman 1956; Abduo & Lyons 2012), with implant texts emphasizing load management and occlusion for longevity.
Material Matters: Provisional vs. Final
Materials Used at Each Stage (and Why)
| Stage | Material | Why We Use It | What Patients Should Expect |
|---|---|---|---|
| Immediate + Healing | Acrylic (chairside/lab) | Fast, repairable, and easy to adjust while tissues stabilize | Looks great day one; expect bite checks/adjustments; not the final set |
| Design Trial | 3D-Printed (Try-In) | Lets us test your new vertical, tooth position, and smile shape | May look “too perfect/bright” before glazing; used for short-term test |
| Approved Design | 3D-Printed + Custom Glazing | Adds natural color, depth, and surface texture before finalizing | Worn for a few weeks → confirm comfort, speech, and appearance |
| Final | Full-Contour Zirconia with Titanium Reinforcement (Rosen Technique) | Strong, highly esthetic, and built for long-term durability | Natural, lifelike, and long-lasting; maintenance preserves your investment |
The Real Workflow (Transparent Timeline)
The Full-Arch Implant Denture Timeline (What Happened and When)
| Step | What Happens | When |
|---|---|---|
| Surgery & Photogrammetry Scan | Full Mouth Extractions + implants placed at Midwest Dental Implantology; Photogrammetry scan that same day | Day 0 |
| Immediate Delivery | Acrylic, implant dentures delivered top and bottom; patient leaves with a full smile. Problem: Open bite on Mrs Jones' right side | Day 1 |
| Early Correction | When bite is off, we rescanned and remade promptly | Day 1-2 |
| Healing Phase | Bite and tissues settle; small adjustments made for comfort; implants fully stabilize | ~6 months |
| Optional Smile Redesign | In this case, We opened the vertical dimension and tested the new smile architecture with 3D-printed implant dentures that the patient wore for a while to test out | After full healing phase |
| Optional Esthetic Refinement | Custom glazing added more natural color, texture, and realism. The initial 3D printed dentures were too bright. | Same day as smile redesign delivery |
| Test-Drive new smile and bite | Patient wears the new dentures and smile in real life — talking, chewing, photos, etc. to make sure it is PERFECT before we deliver the final dentures. | Two weeks |
| Final Delivery | We duplicate the approved design in beautiful Zirconia (Rosen technique) | Final Delivery Day 🎉 about 7 months after surgery in this case |
What Patients Should Learn From This
Immediate load is amazing — you don’t go without teeth.
The first set of dentures isn’t usually permanent, and usually requires adjusting— healing changes things; refinement is normal.
Ultra-white isn’t always “right” — the best smiles add warmth, texture, and translucency. The 3D printed dentures in this case were too bright, but we adjusted them simply to add life and color to Mrs Jones’ smile.
Testing the design in real life (weeks, not minutes) ensures your final looks and feels right. You’re making a big investment! You should feel GREAT about the result.
Team-based care matters — surgery and prosthetics working in sync is how you get predictably great results.
FAQ’s about fixed implant supported dentures
Is it normal to need multiple prostheses?
Yes. You’ll leave surgery with teeth, but the final comes after healing. We adjust design, bite, and esthetics based on real-world wear.
Why not just pick the whitest shade?
Ultra-bright can look flat and fake—especially under daylight and in photos. Characterization (glaze, micro-texture, incisal translucency) makes a smile believable.
Will increasing my bite feel weird?
For a few days, sometimes. That’s why we test-drive your new vertical and smile design before committing to the final.
How long does this take?
Immediate smile: day 1. Healing: about 6 months. Design/test: a few weeks. Final delivery follows promptly after approval.
Partner Acknowledgment
Surgery performed by Midwest Dental Implantology. Lab support from Ottawa Dental Lab. We value collaborative, team-based implant care for safer surgery and better long-term prosthetic outcomes.
Citations
Classic prosthodontic literature ties vertical dimension to facial support, phonetics, and esthetics; implant prosthetics texts emphasize load management and occlusion for longevity (e.g., Turner & Missirlian, J Prosthet Dent 1984; Silverman 1956; Abduo & Lyons, Aust Dent J 2012; Misch, Contemporary Implant Dentistry; Goodacre 2018 review). Translation? The “little” details matter a lot when you want a result that looks natural and lasts.
Ready to Explore Your Options?
If you’re considering full-arch implants in St. Charles, Campton Hills, Elburn, Geneva, or greater Kane County, we’re happy to walk you through immediate load, the test-drive process, and final zirconia options—and show you examples like Mrs. Jones.
-Dr Brayden Teuscher
