Female patient with deteriorated aesthetics, function and tooth contacts
Patient’s upper dentition being non-restorable, as teeth were too mobile to support fixed prostheses in the long term
All upper teeth removed. Implants placed simultaneously. Final fixed prosthesis restored function (mastication, phonetics) . Treatment was reverse-engineered and generated by Facial Analysis and DigitalSmileDesign
Implant-born bridge re-producing the optical features of natural dentition (opalescence,chroma, hue and translucency)
Slightly protruded implant-born prosthesis achieved better lip support. From the very initial phase of implant placement to the delivery of the final restoration, all treatment modalities are evidence-based whereas systematic workflow is followed to secure premium outcomes
Severe periodontitis . Functional and aesthetic collapse. Upper teeth considered non-restorable
Dramatic, in-a-day recovery of aesthetics and function. In extended reconstructions, implant treatment is oftentimes rated as a ”life-changing milestone in one’s life’‘
Micro morphology is faithfully reproduced so that ceramic surfaces display not their ….origins!
Synergy of technology and human’s aesthetic perception of finesse
Severe periodontitis and deterioration of mastication. Dentition not restorable. Systematisation and customised treatment planning can ensure precision and high-end results. Synergy of sophisticated digital workflow (CAD/CAM) and ceramist‘s artistic perception can produce premium results even in mostly complex prosthetic rehabilitations.
Dramatic transition from state of insecurity and embarrassment to confidence and reassurance. In-a-day protocol was followed and implants loaded with fixed prostheses within some hours.
Male patient with failed dentition. Patient suffers from deteriorated function – cannot chew. His complaint is exacerbation of chewing, appearance and phonetics. Findings are : loss of tooth contacts, exaggerated mobility of the upper teeth and respective intrusion of the lower. Occlusal plane i.e. margin of tips of teeth is slanted.
Immediate reconstruction of function and aesthetics. Recovery of health and rehab with reinforced (metal-supported) temporary bridge screwed on implants for strong bite.
We try our best to generate a fine result both in terms of function and aesthetics.
Patient with failed implant-born prosthesis. Prosthetic restoration presents porcelain fractures and inhibits proper mastication
Correction of occlusal plane, that being no slanting occurs. Tips of ceramic upper teeth are now level to horizontal plane. Fine elongation of front teeth restores appearance and function. Natural lip support and fine dynamics of peri-oral muscles.
Metal full-arch foundation milled in CNC machine (CAD/CAM) to secure stiffness and fitting accuracy. Metal foundation was then covered with sophisticated powder porcelain, so as to generate translucency and to mimic morphology of natural teeth
A pleasant form of upper dental synthesis was achieved on a fully guided approach , that consistently secures high-end tailor-made prosthetic reconstructions
As seen on initial photos, prosthetic restorations were disproportional and appeared greyish at the gum outline.
Notably, lower jaw born bridges supported by failed/decayed teeth.
Full clearance of her prostheses was decided.
Strategic placement of 4 state-of-the-art zirconia implants (Straumann) was carried out at the posterior sites of her lower jaw. Zirconia implants are more neutral than Titanium implants, biology-wise. However, since they are one-piece implants (they contain root & abutment segments joined together), they are more difficult to handle during placement. Hence, as they require exquisite precision, they were placed using precision markers /navigators.
Restorability of upper teeth was evaluated and teeth assessed capable of supporting new prostheses.
After gentle removal of upper prostheses (bridges) , dyschromic incisors and canines were revealed (dark grey). Challenge being grey substrate is difficult to mask and to look natural all at the same time. Launch of her reconstruction was trialing aesthetics and function with two series of transitional/temporary set of crowns.
1- Same day immediate temporaries to help patient leave the practice with same-day teeth
2- State-of-the-art printed PMMA bridges within 2 days to enhance durability and aesthetics
4 Zirconia implants placed on the lower posterior segment.
Definitive restorations were 360 Zirconia veneers/crowns on teeth and Zirconia bridges on Zirconia implants.
On lower front teeth translucent zirconia with medium/small strength (450MP) was utilized to help with aesthetics
On upper teeth opaque zirconia was used to help block out grey substrate. In addition, big zirconia 5-unit bridge had to be fabricated from central incisor to 2nd premolar as patient denied implant placement at missing
canine. That demanded an opaque and strong (1200MP) zirconia block to be cut and used as foundation
Whole reconstruction launched with Aesthetic& Functional analysis i.e. DigitalSmileDesign confirmed by custom-made templates as a trial dentition
Special concern was addressed to build new occlusion at the neutral-most position of the lower jaw. At this centric relation all muscles are tense-free, providing the best chewing ability and ease
Male patient presented requesting bite capability be restored.
Examination revealed multiple decay issues having resulted in excessive tooth loss at the posterior segments. Bite was severely affected as no posterior teeth remained.
Strategic placement of implants was decided to help support fixed prostheses (crowns/bridges). Front teeth were cleaned from carries and restored with state-of-the-art full-coverage porcelain veneers – Emax by Ivoclar
Custom made prosthetic components were screwed in implants and combined screw-retained/cemented prostheses were fabricated to minimize interface between implants and supra-structures (crowns). Such a configuration has solid documentation and is proven to help promote longevity of prostheses
360 tooth supported veneers require minimal reduction of teeth. 1 mm is enough on incisors’ edges whereas a 0,5 mm is enough on the front surfaces to help fabrication of bright yet natural-looking ceramics.
Some teeth had grey substrate and were considered a challenge to mask yet provide a uniform shade across the upper and lower jaw.
Design and milling of monolithic e-max cores was done with a full digital setup based on state-of-the-art TRIOS intra-oral scanner and CNC milling machines
Female patient presented to our practice and requested to have her ‘’mouth reconstructed’’.
Medical history included radio-therapy as adjunctive treatment to malignant tumor on larynx (10 years back). Ever since no other malignant findings occurred.
Xerostomia i.e limited saliva was spotted.
Dental findings:
failed teeth and prostheses, severe periodontitis, mal-occlusion due to over-erruption of left teeth as a result to osteoarthritis on her left Temporomandibular joint.
Treatment
Referring specialist surgeon proceeded with tooth extractions and simultaneous placement of 5 implants on upper jaw (immediate placement and loading).
Assessed high-risk as she was due to her medical history, immediate loading was done with reinforced temporary bridge in 2 days. On her temporary aesthetics was enhanced as her front teeth were skeletally protruding (they sticked out). Modifications on her temporary bridge helped reduce that protrusion and served as a guide to fabricate her final bridge after 6 months
Almost simultaneously orthodontic treatment was launched on her lower native teeth to correct severe mal-occlusion (cross-bite)
Female patient presented to our practice and requested to have her ‘’mouth reconstructed’’.
Medical history included radio-therapy as adjunctive treatment to malignant tumor on larynx (10 years back). Ever since no other malignant findings occurred.
Xerostomia i.e limited saliva was spotted.
Dental findings:
failed teeth and prostheses, severe periodontitis, mal-occlusion due to over-erruption of left teeth as a result to osteoarthritis on her left Temporomandibular joint.
Treatment
Referring specialist surgeon proceeded with tooth extractions and simultaneous placement of 5 implants on upper jaw. Patient was immediately restored with reinforced temporary bridge (metal-acrylic).
As several complexities were to be treated, final zirconia bridge had to wait a trial period of six months before placement.
During this period orthodontic treatment was launched on her lower native teeth (braces) to help correct severe mal -occlusion (cross bite)
Additional modifications on her temporary upper dentition were done: protrusion was corrected and prosthetic teeth were moved slightly inward to give a pleasant outcome
Final prosthesis
With state-of-the-art intraoral scanner TRIOS by 3Shape position of her implants was scanned and zirconia framework was cut in milling machine (CNC).
Challenge was to provide smooth tooth contacts due to severe mal-occlusion.
Patient reviewed her prosthesis as fully satisfactory. Hew lower jaw issues are still on hold due to financial impediments
Complex case treated with clearance of all upper teeth, followed by immediate placement of 5 implants and loading with acrylic bridge as a same-day restoration.
Acrylic bridge was replaced by reinforced metal-acrylic long term temporary bridge after 3 days.
Final prosthetic restoration was zirconia bridge and was fabricated 6 months after day of surgery.
