Full-Mouth Rehabilitation with Guided Dental Implants (Paulo Malo Protocol)
Details of the Patient
A 58-year-old retired government employee came to Neo Dental Care, Noida with severely worn, discoloured, and structurally compromised upper front teeth along with missing lower posterior teeth. Dr. Suhrab Singh performed a full-mouth rehabilitation using guided, precision-placed dental implants following the Paulo Malo (All-on-X) framework. The result was a fully functional restoration with exceptionally natural-looking aesthetics and no complications.
PATIENT PROFILE
| Patient Details | |
|---|---|
| Name | Rajendra Sharma |
| Age | 58 years |
| Gender | Male |
| Occupation | Retired Government Employee |
| City | Noida, India |
| Clinical Summary | |
|---|---|
| Presenting Complaint | Worn, discoloured upper front teeth and missing lower posterior teeth affecting appearance and chewing function |
| Diagnosis | Generalised tooth wear and attrition of the upper arch with posterior edentulism in the lower arch |
| Date of Procedure | 2025 |
| Outcome | Excellent |
THE PROBLEM
The “before” picture tells the story on its own: short, worn-down upper front teeth with visible attrition, uneven edges, and a yellowish discolouration that had built up over years. This kind of wear usually develops slowly, from a mix of ageing enamel, grinding habits, and untreated tooth loss elsewhere in the mouth that shifts the bite out of balance.
To make matters harder, several teeth at the back of the lower jaw were missing. Losing back teeth does more than leave a gap; it changes how the remaining teeth meet, and over time the front teeth start absorbing pressure they were never meant to handle. That’s often why worn-down front teeth and missing back teeth show up together, as they did in this case.
By the time the patient came in, the combination was affecting both how they looked and how they chewed. A patchwork fix wasn’t going to hold up. The situation called for a full-mouth plan that addressed the entire upper arch and rebuilt the missing lower posterior teeth together.
CONSULTATION AND TREATMENT PLAN
WHAT WAS ASSESSED DURING THE CONSULTATION
Dr. Suhrab Singh carried out a detailed clinical evaluation before finalising the treatment plan:
- Bone volume and density across the upper arch and lower posterior sites confirmed via CBCT scan
- Extent of tooth wear and attrition on the upper anterior teeth evaluated
- Existing bite (occlusion) and jaw relationship assessed to understand the cause of wear
- Gum health checked around all remaining teeth
- Missing lower posterior teeth sites examined for implant feasibility
- Patient’s functional and aesthetic goals discussed: a full, natural-looking smile and comfortable chewing
WHY GUIDED IMPLANTS WITH THE PAULO MALO FRAMEWORK WERE CHOSEN
- Guided implant placement uses a digital surgical guide for precise positioning, which improves accuracy and reduces surgery time
- The Paulo Malo (All-on-X) protocol allows full-arch rehabilitation using a limited number of strategically angled implants, often avoiding the need for bone grafting
- Rebuilding the lower posterior teeth restored balanced chewing function and took pressure off the upper front teeth
- A full-arch approach addressed the worn upper teeth and the missing lower teeth as one coordinated plan rather than treating each issue in isolation
- The result offers long-term durability along with a natural emergence profile and shade match
PRE-OPERATIVE AND POST-OPERATIVE PHOTOS
Before the procedure, the frontal view showed short, worn upper front teeth with irregular edges and a dull, uneven shade, along with gaps at the back of the lower arch from missing teeth.
The post-operative photograph, taken from the same frontal view, shows a complete, evenly proportioned upper arch with well-aligned, natural-shaded restorations, along with the restored lower posterior teeth. The wear pattern is fully corrected, the bite is balanced across both arches, and the overall smile appears symmetrical and natural.
PROCEDURE DETAILS
Comprehensive clinical and radiographic assessment completed, including CBCT scan for implant planning
Digital treatment plan prepared and a surgical guide fabricated for precision implant placement
Implants placed guided by the digital template at planned sites in the upper arch and lower posterior region
Healing period allowed for osseointegration before proceeding to the restorative phase
Impressions taken once integration was confirmed, for fabrication of the final prosthesis
Restorations fitted following the Paulo Malo framework, with shade and bite verified against the opposing arch
Final occlusal adjustments made and post-op care instructions given
| Procedure Facts | |
|---|---|
| Procedure | Full-Mouth Rehabilitation — Guided Dental Implants (Upper Arch) and Implant-Supported Restoration (Lower Posterior Teeth) |
| Technique | Paulo Malo (All-on-X) guided implant framework |
| Duration | Surgical phase: approx. 3 to 4 hours. Restorative phase (prosthesis fitting): 1 to 1.5 hours |
| Anaesthesia | Local anaesthesia |
| Implant System | Titanium dental implants (root form, tapered design) |
| Restoration Type | All-ceramic zirconia fixed prosthesis, shade-matched to natural teeth |
| Intraoperative Complications | None |
| Hospital Stay | Outpatient, day procedure |
OUTCOMES AT A GLANCE
| Outcome Metric | Result |
|---|---|
| Arch Restoration | Full upper arch and lower posterior teeth restored with guided implants |
| Aesthetic Outcome | Worn, discoloured teeth replaced with natural-shaded, proportionate restoration |
| Functional Outcome | Balanced bite restored across upper and lower arches |
| Symmetry | Even arch alignment and smile symmetry achieved |
| Patient Satisfaction | Very high |
| Complications | None reported |
PATIENT FEEDBACK
Feedback recorded during the follow-up visit at Neo Dental Care, Noida.
|
Google Review ★ ★ ★ ★ ★ 5.0 Verified Patient (Name withheld for privacy) “I had been struggling with my worn-down front teeth and missing back teeth for years, and honestly thought it was too late to fix at my age. Dr. Suhrab and his team explained the whole guided implant process clearly and I never felt anxious about it. My bite feels normal again and I can smile without thinking twice about it. Truly happy with the result.” |
POST-PROCEDURE CARE AND RECOVERY
- Eat soft foods during the initial healing period; avoid hard, crunchy, or sticky foods
- Take prescribed medication as directed for the first few days
- Maintain gentle oral hygiene around the surgical sites as advised
- Avoid smoking, as it can slow healing and affect implant integration
- Attend all scheduled follow-up visits to monitor healing and integration
- Once the final restoration is fitted, brush with a soft-bristle brush and clean around implants daily using recommended aids
| Recovery Timeline | |
|---|---|
| Initial healing phase | Mild swelling/discomfort possible. Soft-food diet recommended. |
| Short-term follow-up | Healing checked, sutures reviewed if applicable. |
| Integration phase | Implants monitored for successful integration with the bone. |
| Restorative phase | Final impressions taken; prosthesis fabricated and fitted. |
| Long-term | Final result stabilises. Annual check-ups recommended. |