At PI, a comprehensive examination, medical history review, and initial photographic and radiographic documentation was completed. This included a full mouth series of intraoral radiographs, a panoramic radiograph, lateral and A-P cephalometric radiographs, diagnostic casts, bite registration, and shade assessment.

The examination revealed:

1. Missing, broken-down, decayed and malpositioned teeth with cross-bite, anterior flaring and midline shift.
2. Advanced, Type IV, generalized periodontal disease with excessive tooth mobility and multiple abscesses.
3. Dental malocclusion with multiple occlusal plane discrepancies and exaggerated curve of Spee.
4. Habitual mentalis posturing to facilitate swallowing.

Tom was advised that simply attempting to repair his teeth was not a viable option. It was recommended that the ideal treatment was complete maxillary and mandibular implant reconstruction. This protocol was presented as full mouth extractions and Teeth in a Day (TIAD) reconstruction for both arches. However, before he could make financial arrangements for the suggested procedures, Tom came back to PI with pain in his lower right quadrant that needed immediate attention. A temporary Immediate Denture was suggested.

After appropriate impressions, bite records and updated photographs were taken; the mandibular right quadrant was edentulated. Gross infection was present, so biopsies were taken for histologic analysis. Four days later, the full mouth extractions were completed. The immediate dentures were relined with tissue conditioner (Viscogel). Healing progressed normally.