Combined tooth and implant-supported overdenture?

Provisional wax-ups followed by mounted models to open the bite before any work is done. Treatment partial dentures will give the patient an idea of the esthetics and any changes that can be made. All the procedures can be done on models which will help the technician and dentist design a superior product. In certain cases implants can be attached to teeth , but not in this case. Good luck.

On upper jaw you could do partial denture with telescopic crowns on all remaining teeth with no implants at all. Considering the bone situation, that would be my first choice.

I think you are setting yourself up for a tremendous failure if you attempt to do implants on this case. If the patient insists, then refer. A combination of crown and bridge, and a removable partial denture would, in my estimation, result in a satisfactory and resonable result. On the mandibular portion of the treatment you are also facing a complex situation.

Think about the occlusal and functional reasons this patient has lost their teeth and bone and is suffering from a collapse in vertical dimension. Dental implants are not bullet proof. They will fail just as this patient's teeth have failed. Very tough case that requires careful planning with models, a good lab that can make serial provisional removables, and a very compliant patient with lots of time and funds. Be careful.

All-on-4 is in my experience a desperate answer to a desperate condition. Please remember the extension of the restoration based on the AP measurements (anteroposterior ). If patient can afford a traditional solution (and implants) this would provide many answers for further treatment. While that goes on some research into your plan should go on and a conclusion made. There are many traps in complicated cases and a good plan is 75% of the job.

As has been suggested, this is a complex case and perhaps not the best one to start with. I would recommend that you at least discuss the case with a prosthodontist colleague (and perhaps an oral surgeon). Most particularly you need to establish reasonable occlusal planes and a good vertical dimension. With this in mind it would not be silly to restore initially with partial dentures (including the lower) just to test to vertical dimension and planes. Of course you could do diagnostic wax ups but in the end you need to check the proposed positioning in the mouth. Once the patient and you are happy, you could proceed with whatever final treatment you wish. I suspect that the implants in the upper and partial denture are going to be easy compared to the rest of the treatment. In regards to your question about an implant retained denture in combination with natural teeth, there should be no problems. I do this all the time. The only decision is whether to use locators or ball abutments (and this is usually decided in the laboratory after surveying the model for path of insertion).

Based on the diagnostic description and from prosthodontist point of view I would unite all upper teeth with a PFM bridge. I would also unite the lower teeth with PFM crowns and then restore the lower posterior area with a metal frame removable prosthesis. This is the cheapest and safest way for the patient to restore his masticatory and cosmetic functions. I doubt that the implants insertion can be a more beneficial solution for the patient.

I would not be surprised if the person who asked the question was not more confused than before. It should be obvious that the patient is the first one to decide what he wants. Everything will depend on patient time to completion expectation, results and prognosis, finances. The intermediate stage is not possible to avoid which means removable restorations even if just to determine implants placement locations, feasibility to achieve what patient expects. Expectation is a big item in planning because it may end up being a case one regrets he/she ever got involved with. In summary, there is no one to go about delivering the treatment to satisfy the patient.