Dental Implant Supported Bridgework - Patient Story

Maxillary full implant supported bridgework, Mandibular (lower arch) fixed tooth supported crowns & bridgework.

The patient had failing aesthetics: missing teeth, failing crowns and bridgework affecting her comfort, function and aesthetics. This was further compounded by the presence of a 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 confidence and chew with comfort”. The concern was to improve the upper arch shape and smile line as well as tooth colour. This lovely patient wanted to smile and chew her food confidently.

The patient was referred by her dentist, seeking a specialist’s opinion, and treatment in relation to a 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 defects that was replaced by a 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, I 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.

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

Diagnosis

Unacceptable dental aesthetics and 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 she never left the practice without teeth, the provisional bridgework as both aesthetic and function.

Treatment

Following with discussion of all risks and treatment modalities with our patient that included

No treatment: this is not an option as the restorations are failing and affecting longevity of supporting teeth
Repair existing restorations and make removable partial denture: this is a temporary measure and not accepted by the patient
Fixed option: implant & tooth supported crowns and bridgework, described below

Removal of failing bridgework

Creating an upper lip and profile creating a youthful, fresher look with provisional restorations two months post implant placement

Placement of 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.
Why? Because during the provisionalisation phase this is the best opportunity for 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.
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, and aesthetics.

We need to improve the upper lip profile: This was completed. Final treatment outcome: we have restored aesthetics comfort and 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 bone. Is best not to rush biology and allow optimal healing.

Note improvement in lip thickness and support in combination with correcting protruding maxillary central incisors

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 an improve jaw line. This is most important for women with missing back teeth to reduce lower facial folding.

Final treatment outcome

We have restored aesthetics comfort and function. However most importantly we have complemented our lovely patient’s facial aesthetics. We have a confident and happy patient

Thank you for taking the time to explore this patient’s story. I hope this gives you an idea of what I can do for you if you are having difficulty and need help, because there is always hope.

Dr. Sarkis Nalbandian
Visiting Professor YSMU
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) FIADE, FPFA