All on 4, so unhappy with temporary look, please help. (photos)

Than you for posting your question and photos.  First and foremost, remember that these are only your temporary teeth and most of your concerns can be addressed before getting your final teeth.  One nice way to get a preview of how things will look before getting your final set of teeth is a "wax try-in".  With a wax try-in, your dentist removes your temporary teeth and places a set of "wax try-in teeth" into your mouth.  The wax try in teeth are basically a mock up of what your permanent teeth will look like.  These are typically denture teeth set in wax and they look just like your final All-On-4 bridge.  The dentist screws the wax teeth onto your implants and you get a preview of what the final teeth will look like.  If you want to have changes made, that is very easy to do.  The wax teeth are unscrewed and the changes are immediately made in the wax.  Then the dentist screws the teeth back in so you can evaluate the changes.  This is a nice technique because it allows you to evaluation lip support, face support, the amount of tooth show, confirming the midline of the teeth is in harmony with the midline of your face, etc.  Also, it allows you to be confident that you will like your permanent set of teeth.
Oh yes, you will never leave the dentist office with the wax teeth.  They will melt!  Your dentist will always put your temporary teeth back on before you leave the office.  The wax teeth will then be scanned in a computer and duplicated into your permanent teeth. 
I published an article on this topic in the Journal of Cosmetic Dentistry in 2014.  

The good news is that this is only the temporary meant to serve as a healing prosthesis.  Often times its hard to determine the final aesthetics as there is no chance for a try-in and surgical surprises do occur   The good news is that it can all be fixed for the final.Good luck

Hi and Thank you for you question:

There are many factors that affect the esthetics of any denture even if supported by implants. There needs to be a consideration to the lip line at rest, the smile line and the soft tissue support provided by the denture. The best option you have at this point is to visit a Prosthodontits ( specialist for crowns, bridges, dentures and implant restorations) so that you can get properly evaluated. I sincerely hope you get the help you need, Good Luck!!!

In regards to appearance and support for the face, this can be corrected by positioning the teeth appropriately. However it may not result in a 100% correction. Patients who have lost their teeth do also suffer from massive amounts of bone shrinkage and this does result in them having thin lips.



The height of the face can be restored

The support of the lip can be restored



You may need some dermal fillers to enhance the appearance of your lips



Hope that helps



All the best

It is a true blessing that in 2016 we can extract teeth, place implants and deliver a stable, Previously designed, temporary denture in the course of one surgical appointment.  The temporary denture allows the patient to go back into society without the embarrassment of not having any teeth at all. This temporary will allow the dentist to assess function and esthetics while integration of the implants is occurring and the patient is able to assimilate socially. The temporary "All-on-4" is an ideal time to address any concerns with the size and shape of the teeth or lip support.  This is a very complex type of dentistry and many things may have to be worked out in this intricate process.  I am certain that if you express your concerns and understand that it is a process, you will have an great result in the final "All-on-4" implant retained prosthesis.

Both dentures and all on 4 restorations can be used very effectively to make your lips and face appear fuller.Simply express your concerns to your dentist and I'm sure they can easily create this effect for you.I hope you found this information to be helpful,Dr. Champagne 

General considerations would be an evaluation of the vertical dimension created when your teeth meet each other (your dentist would understand these terms). Evaluating a profile view to determine if the teeth can be repositioned further out, and lastly, an evaluation of the apparent slant that the edges of your prosthetic teeth demonstrate at rest and when you smile. The photos you provided are a great starting point, but I would definitely need to evaluate more clinical information to give you a definitive response. 

To properly advise you, we would need to see before photos as well as after photos. In my experience, many patients before treatment are so focused on what they don't like about their teeth that they don't notice other things, like lip position, smile line, facial profile, etc. Having said this, in my experience as the restorative dentist for many all-on-4 cases, it can be difficult to achieve exactly the perfect position of the healing dentures. Regardless, this is something to discuss well with your restoring dentist as she or he prepares to make your final smile. Make sure your concerns are heard and satisfied at any try in stage possible so at the end you have the smile you are hoping for!