Complex prosthetic reconstruction on teeth and zirconia implants

Female patient presented with multiple issues: Chewing ability compromised, unpleasant appearance of the upper.

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

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