Designer Smiles
Dental facelift: Complex Aesthetics

Maxillary full implant supported bridgework
Mandibular (lower arch) fixed tooth supported crowns & bridgework
Failed aesthetics: missing teeth, failing crowns and bridgework affecting patients comfort, function and aesthetics. This is further compounded by the presence of mobile partial denture and general discomfort.
Treatment: reconstruction of maxilla (upper arch) and mandible (lower arch) using tooth supported and implant supported crowns and site augmentation (soft and hard tissue grafting) where teeth have failed that require removal.

This study will show

  • Complexity of treatment
  • Treatment outcome
  • Patient’s assessment
  • Please refer to the video provided

Chief concerns: “I want to smile with confident and chew with comfort””. The concern is to improve the upper arch shape and smile line as well as tooth colour. This lovely patient wants to smile and chew her food confidently.

img1
img2

Initial Presentation

3

Mrs J. was referred by her dentist, seeking specialist’s opinion and treatment in relation to fixed option of restoring missing teeth and failing dentition as well as tooth supported crowns. The loss of teeth from failing bridgework has left considerable soft and hard tissue defect that was replaced by partial denture.

We have unacceptable aesthetics and function. It’s surprising to see how much patients can tolerate with broken down dentition. I guess we all are busy in our lives, looking after the family and finally when everyone is ok, it time for us.

In general, whenever possible we would like to replace, or at least get close to the foundation bone and gum tissues to allow optimal tooth position in the arch that creates natural aesthetics.

Missing teeth replaced by partial removable denture

Although the existing crowns and partial denture are holding well during dull smile, unfortunately the existing restorations are failing at gum margins with fractured roots not shown in the images. The lower teeth with multiple repairs was also concern with discoloured crown margins, unnatural teeth: colour, form, progression & gum line.

4

Diagnosis: Unacceptable dental aesthetics & function due dissatisfaction with failing fixed restorations, mmissing teet and general tooth discolouration

Our Aim: to improve the aesthetics of upper arch: tooth shape, display, tooth colour, length, symmetry and smile line in general, using implant-supported fixed bridgework and tooth-supported crowns and bridgework in the lower arch. This was accomplished with minimal discomfort to the patient and Mrs J. Never left the practice without missing teeth. The provisional bridgework as both aesthetic and function (please Videos provided).
Treatment
Following with discussion of all risks and treatment modalities with our patient that included
  1. No treatment: this is not an option as the restorations are failing and affecting the longevity of supporting teeth
  2. Repair existing restorations and make removable partial denture: this is a temporary measure and not accepted by the patient
  3. Fixed option: implant & tooth supported crowns and bridgework, described below
26
New Project6

Removal of failing bridgeworks
Creating an upper lip and profile creating a youthful, fresher look with provisional restorations 2 months post-implant placement.

  1. Placement if implants: Upper arch to support fixed porcelain bridgework Temporary bridgework while implants are integrating with bone: we also have the opportunity to improve upper lip and facial support. The aim is to “evert” the upper lip and profile creating a youthful, fresher look.
  2. Why? Because during the provisionalisation phase this is the best opportunity by the specialist to show the patient the possibilities. Once approved by the patient, this “template “can be copied with further improvement in the final bridgework.
  3. Finalize the treatment for both arches with implant and tooth supported crowns and bridgework. The Provisional restorations for that important confidence for normative function comfort & aesthetics.

We need to improve the upper lip profile: This was completed.
Final treatment outcome: we have restored esthetics comfort & function and we have a happy patient

Procedure & Results

Clinical: Reconstruction of upper arch: implant supported bridgework & tooth supported crowns

The work was completed in six months and implants to integrate with the bone. Is best not to rush biology and allow optimal healing.

Note improvement in lip thickness & support in a combination of correcting protruding maxillary central incisors

Full lower arch reconstruction using special porcelain technology to restore tooth anatomy strength colour

Clinical: Reconstruction of upper arch: implant supported bridgework &tooth supported crowns

Your Teeth Are Fixed in the Jaw with Implants!

Full lower arch reconstruction using special porcelain technology to restore tooth anatomy strength colour

Full lower arch reconstruction using special porcelain technology to restore tooth anatomy strength colour Lower arch positioned forward for improved lip support

We also extended the arch length to give fuller and complete lower smile line and lower cheek support for improve jaw line. This is most important for women with missing back teeth to reduce lower facial folding

New Project 14
New Project 15
New Project 16
New Project 17

Final treatment outcome: we have restored aesthetics comfort & function.

However most importantly we have complemented our lovely patient’s facial aesthetics.

Final treatment outcome and we have a confident and happy patient

Dr. Sarkis Nalbandian

Registered Specialist   

Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London

D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)

24
New Project 18
New Project 19

4 YEARS POST OP