From Congenital Absence to Full-Arch Function
- The Aurum Group
- 6 hours ago
- 5 min read
A Restorative Journey by Dr. Brad Bishop, Certified Specialist in Prosthodontics - Kelowna, BC
When I first met Elan, he was 19 years old. He had been referred to our team for evaluation of implant-supported prosthetic options, but his case was unlike most full-arch consultations. Elan has ectodermal dysplasia, and as a result, his dental development has been profoundly affected. He presented with only two permanent teeth—his maxillary canines—and had relied on an acrylic partial denture for most of his life.
He wasn’t transitioning from a failing dentition. He had never had a full set of teeth to begin with. From the outset, I understood that this case would require not just surgical and prosthetic planning, but developmental sensitivity. We weren’t replacing something familiar—we were introducing a completely new functional reality.
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.
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, AURUMTEK® 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, notjust 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 re-framed 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.
February 11, 2026
By combining AI-powered design, a fully digital workflow, and precision-engineered prostheses, it reduces chair time, improves patient comfort, and delivers predictable, industry-leading results—making complex full-arch cases simpler, faster, and more reliable than ever.
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