CASE STUDY
- Patient: Robert
- Treatment: Platinum Package, Full Mouth Dental Implants, Upper and Lower Arch
- Substructure: Chrome framework with individual teeth, both arches
- Treating Clinician: Dr Nikhil Oberai MSc · GDC No. 150126
- Presenting Situation: Very nervous patient. Severe gag reflex. Required full mouth rehabilitation, upper and lower jaw. Remaining teeth extracted.
- Outcome: Implants and temporary fixed bridge placed same day on both arches. Permanent chrome framework bridge designed to his facial profile after three-month healing period. Over a year later, completely overjoyed. Still smiling. Still enjoying family life.
He was nervous. He had a severe gag reflex. He went ahead anyway. And it changed his life.
Robert is a patient I have a great deal of respect for. Not because his case was the most complex I have treated, though it had its challenges, but because of what it took for him to walk through the door in the first place.
He is a genuinely nervous patient. He has a severe gag reflex, which makes dental treatment significantly more challenging and more daunting to undergo. The combination of those two things means that for many patients in Robert’s position, the decision to pursue implant treatment, let alone full mouth rehabilitation on both arches, never gets made. It feels like too much.
Robert made it. He came in, we talked through everything in detail, and he decided that the life he wanted on the other side of treatment was worth doing what was needed to get there. Over a year later he is completely overjoyed with his choice and still enjoying smiling and spending time with his family.
That is why I do this work.
A nervous patient with a difficult dental history and a decision that took courage.
Robert’s situation before treatment was one he had been managing for some time. Dental anxiety at the level he experienced is not something that resolves on its own. For many patients it compounds over years as each avoided appointment allows the dental situation to deteriorate further, which makes the eventual treatment more extensive, which makes the anxiety worse.
A severe gag reflex adds a specific and significant layer of difficulty to any dental procedure. It is not simply discomfort or nervousness. It is a physiological response that can make it genuinely difficult to carry out examination, let alone surgery, without careful management and the right approach from the treating clinician.
Robert needed full mouth rehabilitation on both the upper and lower jaw. This is the most comprehensive implant treatment available. In a patient with his level of anxiety and his gag reflex, it required a particularly thoughtful and patient-centred approach from the first consultation through to the last appointment.
After going through the options in detail, Robert decided on the Platinum Package. Both arches. Complete fixed teeth. Temporary bridge on the same day. Permanent chrome framework bridge designed to his facial profile after healing. He made a brave decision and committed to it fully.
- The consultation and treatment plan
A severe gag reflex is not a barrier. It is something to be managed, with the right approach.
I want to say something directly for any patient who is reading Robert’s story and recognising themselves in the description of his anxiety or his gag reflex.
A severe gag reflex does not make implant treatment impossible. It makes it more challenging and it requires a clinician who understands how to manage it carefully throughout. The approach involves taking extra time at every stage, explaining each step before it happens, using techniques that minimise the stimulus, and being genuinely responsive to how the patient is doing throughout the procedure.
Sedation is also available for all procedures at both my Northwich and Wilmslow practices. For patients whose anxiety makes treatment without sedation feel unmanageable, this is always an option we discuss openly. Robert’s case involved careful management of both the gag reflex and his anxiety throughout, and the fact that he went through full mouth rehabilitation on both arches speaks to what is possible when that management is done well.
If you have significant dental anxiety or a gag reflex and you have been putting off treatment as a result, please come and speak to me. The consultation is not a procedure. It is a conversation. We go at your pace entirely.
- Real Patient Results
Thousands of Smiles Transformed
Be our Next Success Story!
Experience personalised dental care designed to help you achieve your dream smile.
Both arches. Chrome framework. A smile designed for his face.
After a thorough assessment and detailed discussion of the options, Robert chose the Platinum Package. This covers both the upper and lower arch with the same full arch protocol applied to each jaw. Implants placed, temporary bridge the same day, permanent chrome framework bridge after healing.
The chrome framework substructure was chosen for its strength and precision. Individual teeth are built onto the framework and the whole restoration is designed to suit the patient’s facial profile, not a generic template. Getting the smile design right for Robert, specifically, was as important as getting the surgical elements right.
The treatment plan was discussed in full with Robert before any appointment was booked. Every stage, every cost, and every element of what the day of surgery would involve was explained clearly. For a nervous patient, preparation and predictability reduce anxiety more effectively than anything else. Nothing came as a surprise to Robert on the day.
Both arches treated. Fixed teeth on both jaws on the same day.
On the day of surgery, the remaining teeth in both the upper and lower jaw were carefully extracted and implants were placed in both arches in the same appointment. A temporary fixed bridge was then secured on both arches before Robert left the practice.
He came in that day without a functional smile on either arch. He left with fixed teeth, top and bottom, on the same day as the surgery.
That is a significant moment under any circumstances. For a patient as anxious as Robert, with the additional challenge of his gag reflex, it represented something beyond just the clinical outcome. He had done the thing he had been building up to and the result was immediate. Fixed. Complete. His.
After a healing period of three months, construction of the permanent bridges began. The chrome framework for both arches was fabricated and the individual teeth designed to suit Robert’s facial profile. The staged impression and try-in process gave Robert the opportunity to see and confirm the aesthetic result before anything permanent was fitted. He was involved in every decision.
When the permanent bridges were placed, the Platinum Package treatment was complete.
Not sure where to begin? Speak to someone.
Explore Related Treatments
- The result
Over a year later. Completely overjoyed. Still smiling. Still enjoying family life.
It has been over a year since Robert’s treatment was completed. He is completely overjoyed with his choice. He is still enjoying smiling. He is spending time with his family without his teeth being something he has to think or worry about.
That last part is what matters most. The absence of the worry. For patients who have carried significant dental anxiety and a deteriorating dental situation for years, the mental freedom that comes when the situation is resolved properly is something that is genuinely difficult to quantify. Robert’s own description of his experience says more than any clinical metric could.
The chrome framework bridges, designed to his facial profile and fitted after careful staging and try-in, look natural and have remained stable and comfortable. The result is what we planned. The longevity of Robert’s satisfaction with it is the evidence that it was done to the right standard.
- Dr Nikhil reflects
Every nervous patient who goes ahead with treatment is doing something that takes real courage.
I want to be direct about something. Treating a patient with significant dental anxiety and a severe gag reflex through full mouth rehabilitation on both arches is not a routine experience for either the patient or the treating clinician. It requires patience, attentiveness, and a genuine commitment to the patient’s comfort and sense of control throughout every appointment.
What Robert did took courage. Real courage. The kind that comes from deciding that the life you want on the other side of the treatment is worth the difficulty of getting there. I have enormous respect for patients who make that decision and follow through on it.
If you are a nervous patient and you have been reading Robert’s story wondering whether something similar would be possible for you, the answer is that I would very much like to find out with you. Come and have a conversation. Bring your questions and your concerns. We will go at your pace entirely.
If you are looking for similar treatment, I look forward to seeing you at the practice to discuss how we can improve your smile and your lifestyle.
“For every problem, there is a solution. It might be challenging, but it is almost always possible.”
“It has been over a year since his treatment and we can successfully say he is still enjoying smiling and spending time with his family. He is completely overjoyed with his choice.” — Dr Nikhil Oberai, on Robert’s outcome
- Treatment involved
Platinum Package, Full Mouth Implants, Upper and Lower Arch, Chrome Framework
Robert had the Platinum Package, replacing all teeth on both the upper and lower arch with dental implants. Remaining teeth were extracted and implants placed in both jaws in the same appointment, with a temporary fixed bridge fitted on the same day. Following a three-month healing period, permanent chrome framework bridges with individual teeth designed to his facial profile were constructed and fitted on both arches.
The Platinum Package at my Northwich and Wilmslow practices starts from £19,500 for both arches. 0% finance is available through Tabeo over 12 months.