Patient presented with several missing teeth, many old worn-down crowns and an upper partial denture that replaced four teeth. Her bite had shifted significantly on one side. Some of her teeth needed to be removed and others were in salvageable condition. She wanted a permanent solution and teeth that she didn’t have to take in and out. She also wanted something permanent that would last her through the rest of her life without ever having to deal with future decay or breakage, so she opted to replace all of the upper teeth with implants and fixed bridges and have 8 new crowns for the lower back teeth. She was very happy with her decision.
Pre-treatment, close up view, lips retracted, excursive bite
Pre-treatment: Upper arch, partial denture in place.
Pre-treatment: Upper arch without partial.
Pre-treatment, lower arch.
Pre-treatment: Right lateral view.
Pre-treatment: Left lateral view.
Pre-treatment: Articulator frontal view. Notice the upper left area, where there are teeth missing. After these upper teeth were removed, everything slowly started drifting toward the open space, resulting in an uneven occlusion, even with wearing a partial denture.
Pre-treatment: Articulator right side view. Notice how the lower molars have grown up into the space where the upper molars once were?
Pre-treatment: Articulator left side view. You can also see on this side where the lower teeth began to gravitate upward to fill the open space. Her bite needed to be opened back up. This was achieved with the final restorations.
Pre-treatment panoramic x-ray.
Surgical removal of all upper teeth and implant placement (x 6), and bone grafting was all done the same day.
You can see here just how thin the bony ridge was in some areas. We did add bone around these implants at the time of placement, and waited 6 months before making the final prosthesis.
Measuring for the implants.
Here, you can see just why bone grafting was necessary. The ridge was thicker at the crest and thinner up in the vestibule area. We added bone all around the implants and over the next 6 months, it filled in quite nicely, providing good, solid support for the implants.
A custom guide was made ahead of time to help select the best positions for the implants. Because this was a FIXED prosthesis and not a removeable prosthesis with “pink” areas to hide the attachments under, they needed to be placed very precisely, in sites and in positions that would allow for fabrication of the metal understructure as well as the porcelain teeth, with the proper esthetics. Precise placement: THIS is a critical part of these treatments! This is just another good reason to have the Restorative dentist directly involved with the Surgical phase of treatment. He knows EXACTLY where those implants need to be placed for ideal esthetic results!
Another view of the guide in place to help for precise implant position placement. You can see here why the exact location and position of each implant is critical. There needs to be room around the head of each implant for the metal framework for each crown and bridge as well as for the porcelain over that metal framework. And the space around each implant needs to be adequate to allow for proper fabrication of the restorations: For enough metal and porcelain to support a strong bite without the porcelain fracturing.
Temporary bridge, placed the same day of the extractions and implants. (“Immediate Fixed Temporary”).
Temporary bridge in place. This photo was taken 9 days after the surgery. The soft tissues are healing well and all is stable.
Upper arch view of temporary bridge 9 days post-surgery. Looking good!
Upper implants, 3 months after placement. Wearing the immediate temporary fixed bridge has helped mold the gum tissues into a proper position, with scalloped edges around each tooth. This will greatly improve the end result with the final crowns fitting naturally with the gums.
Arch view of implants healing, at 3 months post-surgery.
This view shows the scalloped edges of the gums a little better. This is a really important part in natural-looking end results. If this patient had to wear a removable temporary prosthesis for six months, the gum levels would flatten out some, and the esthetic result would be black triangles between the teeth. Luckily, for this patient, we WERE able to do immediate fixed temporaries.
These are the temporaries at 3 months post-surgery.
Master cast with implant analogs in place.
Final crowns on cast, occlusal view.
Final crowns on cast, frontal view.
These are the temporaries at 6 months post-surgery, frontal view. The implants and soft tissues are now ready for the final restorations!
These are the temporaries at 6 months post-surgery, occlusal view.
Final crowns and bridges – occlusal view.
Final crowns and bridges – left lateral view.
Final crowns and bridges – right lateral view.
Lower arch (not treated)
Final restorations – frontal view, lips retracted.
Final implant crowns and bridges – smile view.
Patient presented with several missing teeth, many old worn-down crowns and an upper partial denture that replaced four teeth. Her bite had shifted significantly on one side. Some of her teeth needed to be removed and others were in salvageable condition. She wanted a permanent solution and teeth that she didn’t have to take in and out. She also wanted something permanent that would last her through the rest of her life without ever having to deal with future decay or breakage, so she opted to replace all of the upper teeth with implants and fixed bridges and have 8 new crowns for the lower back teeth. She was very happy with her decision.
Pre-treatment, close up view, lips retracted, excursive bite
Pre-treatment: Upper arch, partial denture in place.
Pre-treatment: Upper arch without partial.
Pre-treatment, lower arch.
Pre-treatment: Right lateral view.
Pre-treatment: Left lateral view.
Pre-treatment: Articulator frontal view. Notice the upper left area, where there are teeth missing. After these upper teeth were removed, everything slowly started drifting toward the open space, resulting in an uneven occlusion, even with wearing a partial denture.
Pre-treatment: Articulator right side view. Notice how the lower molars have grown up into the space where the upper molars once were?
Pre-treatment: Articulator left side view. You can also see on this side where the lower teeth began to gravitate upward to fill the open space. Her bite needed to be opened back up. This was achieved with the final restorations.
Pre-treatment panoramic x-ray.
Surgical removal of all upper teeth and implant placement (x 6), and bone grafting was all done the same day.
You can see here just how thin the bony ridge was in some areas. We did add bone around these implants at the time of placement, and waited 6 months before making the final prosthesis.
Measuring for the implants.
Here, you can see just why bone grafting was necessary. The ridge was thicker at the crest and thinner up in the vestibule area. We added bone all around the implants and over the next 6 months, it filled in quite nicely, providing good, solid support for the implants.
A custom guide was made ahead of time to help select the best positions for the implants. Because this was a FIXED prosthesis and not a removeable prosthesis with “pink” areas to hide the attachments under, they needed to be placed very precisely, in sites and in positions that would allow for fabrication of the metal understructure as well as the porcelain teeth, with the proper esthetics. Precise placement: THIS is a critical part of these treatments! This is just another good reason to have the Restorative dentist directly involved with the Surgical phase of treatment. He knows EXACTLY where those implants need to be placed for ideal esthetic results!
Another view of the guide in place to help for precise implant position placement. You can see here why the exact location and position of each implant is critical. There needs to be room around the head of each implant for the metal framework for each crown and bridge as well as for the porcelain over that metal framework. And the space around each implant needs to be adequate to allow for proper fabrication of the restorations: For enough metal and porcelain to support a strong bite without the porcelain fracturing.
Temporary bridge, placed the same day of the extractions and implants. (“Immediate Fixed Temporary”).
Temporary bridge in place. This photo was taken 9 days after the surgery. The soft tissues are healing well and all is stable.
Upper arch view of temporary bridge 9 days post-surgery. Looking good!
Upper implants, 3 months after placement. Wearing the immediate temporary fixed bridge has helped mold the gum tissues into a proper position, with scalloped edges around each tooth. This will greatly improve the end result with the final crowns fitting naturally with the gums.
Arch view of implants healing, at 3 months post-surgery.
This view shows the scalloped edges of the gums a little better. This is a really important part in natural-looking end results. If this patient had to wear a removable temporary prosthesis for six months, the gum levels would flatten out some, and the esthetic result would be black triangles between the teeth. Luckily, for this patient, we WERE able to do immediate fixed temporaries.
These are the temporaries at 3 months post-surgery.
Master cast with implant analogs in place.
Final crowns on cast, occlusal view.
Final crowns on cast, frontal view.
These are the temporaries at 6 months post-surgery, frontal view. The implants and soft tissues are now ready for the final restorations!
These are the temporaries at 6 months post-surgery, occlusal view.
Final crowns and bridges – occlusal view.
Final crowns and bridges – left lateral view.
Final crowns and bridges – right lateral view.
Lower arch (not treated)
Final restorations – frontal view, lips retracted.
