Full teeth Implant supported fixed maxillary (upper) bridgework

“Dr Nalbandian, with my existing bridgework placed some 10 years ago, I have not been able to smile and have totally neglected my teeth. Please can you help me in restoring my smile? I know that I need dental implants!”

“I have simply lost my desire to smile and look angry. I simply do not like my teeth!”

The implant supported bridgework. Note how the tooth form, arch form and gum form are carefully created to match the patient’s lost gum tissue and missing teeth which improve her smile, lip and facial support.




“Dr Nalbandian, with my existing bridgework placed some 10 years ago, I have not been able to smile and have totally neglected my teeth. Please can you help me in restoring my smile? I know that I need dental implants!”

“I have simply lost my desire to smile and look angry” I simply do not like my teeth!

Note the presence of bulky upper lip due to poor upper bridgework design, pushing the upper lip forward. Incorrect bite relationship that was not corrected prior to upper bridgework construction has allowed further upward migration of lower front teeth, further adding to the visual stain in speech and smile.



The untreated periodontal disease and incorrect bite has also created unnecessary lower teeth super eruption, creating unaesthetic smile line.



Incorrect dental treatment planning leads to treatment failure!

Failing: maxillary (upper arch) bridgework. Chronic advanced periodontal (gum) disease.

We need to treat the periodontal disease prior to any implant therapy. Otherwise implants will also fail, irrespective of how much the implant dentistry costs, implant integration with the bone will fail, if you do not carry out home and professional care.

Those patients who have regular dental recare assessment and cleanings(prohylaxis) have the least problems.



Upper Arch: terminal dentition supporting the upper porcelain bridgework. The treatment planning involved the following;

1. Control the periodontal disease‐ extensive periodontal treatment
2. Planning the implant placement on the upper arch and removing teeth with hopeless prognosis supporting the upper bridgework.
3. The important part of the treatment plan was that the patient NEVER walked out from our surgery without fixed teeth in her mouth. The new provisional bridgework was placed on provisional implants and on the upper back teeth which we decided to retain.
4. The importance of careful planning involved meticulous assessment of every tooth in the mouth, bone level and gum health home care by the patient. Unless the patient is able to continue the home care, we generally refuse to provide any extensive dental implant therapy.



5. Note how we retained the back molars on the upper arch.
6. We would like to maintain as much sound natural teeth as possible



7. The implant supported bridgework. Note how the tooth form, arch form and gum form are carefully created to match the patient’s lost gum tissue and missing teeth which improve her smile, lip and facial support.
8. Clinical stages in implant supported full arch bridge issue.
9. Engineering at its best. We allow a tolerance of 30‐40μm in the mouth. The thickness of hair is 100 μm!



Aesthetics at its best: difficult to tell the transition line between the bridgework gums and pink tissues



X‐ray for 46 implant restored crown. Periodontal therapy on the upper and lower jaws, we managed to retain all lower teeth and improved teeth prognosis in general. Good cortication: bone stability is achieved. This case is now 5 years post op.



Restoring form function and aesthetics.

Dentistry is a combination of art and science

A systematic review in 2004 that reported a 5‐year bridge survival rate of 95.4% and a 10‐year survival rate of 93%, with no complications in 61% of patients. The reported complications were bridge fracture, screw loosening, veneer fracture and implant fracture. (Pjetursson BE, Tan K, Lang NP, Brägger U, Egger M, Zwahlen M. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years. Clin Oral Implants Res. 2004;15(6):625‐42 Review.)



BEFORE: The old bridge made the upper lip more prominent and unnatural. This patient was unable to smile for years, with reduced confidence!


AFTER: Implant supported reconstructions. Note lips assume natural profile when all the teeth are in the correct place. The lower teeth were levelled to correct smile line.

Microsoft Word - Full teeth Bridges.docx It is not the implant. It is the final superstructure that fits the face and complements patient’s dentofacial aesthetics. However, there is a strong belief that fixed implant prostheses meet with greater patient acceptance and satisfaction

Fixed maxillary (upper jaw) prosthesis designs are associated with significant improvements in comfort and retention, function, aesthetics and appearance, taste, speech and self‐esteem.






Patients want teeth and to be able to eat, taste, talk, smile and not just an implant, which is a titanium screw bolted to the jaw (in a crued format). Restoring lip fom, smile line, comfort, function and aesthetics.

One Smile says it all!

Implants have provided fixed scaffolding to rebuild this wonderful patient’s lower half of the face and not just the teeth. It’s not just about the teeth, it’s about the face!

Helping our patients enjoy their lives

Now I can smile again and get on with my life!

Full teeth Implant supported fixed maxillary (upper) bridgework.6 Year Case Study 2


The first Australian full‐arch implant‐supported Zirconia fixed bridgework.

The dental community is increasingly moving towards non‐metallic based restorations. The implant dentistry and its prosthetic applications have been at the forefront of these technological changes. Consequently, direct screwretained full‐arch bridgework was constructed to produce aesthetically and functionally appropriate morphology (shape, form and tooth arrangement). Zirconia, a bio‐inert material, exhibits some form of translucency and high flexural strength due to high crystal density.

The method described in this case study was used for the treatment of a 52 year old Caucasian woman referred for surgical implant placement and final prosthetic reconstruction. Patient presented with terminal dentition; smoking history, bone loss affected by advanced chronic periodontitis but otherwise healthy with no known allergies Treatment plan comprised initially proceeding with maxillary clearance and immediate implant placement with provisional abutments and bridgework to provide temporary support, comfort, function and aesthetics. Lower arch reconstruction to be followed in near future.

The surgical procedure was as follows: immediate placement of six fixtures in the maxilla at sites 15, 14, 13, 22, 24 25 with excellent primary stability obtained. Initially, provisional abutments were used to house provisiona bridgework. Three months later, the final impression was taken at correct bite for construction of zirconia framework and final bridgework.



Preoperative: Intra Oral view of terminal dentition and occlusal view Post operative: occlusal view of osseointegrated implants. Optimal implant positioning for direct screw access Laboratory and the technician have live view of the smile dynamics.



Post operative: occlusal view of osseointegrated implants. Optimal implant positioning for direct screw access. Initial full smile mock up assessed and approved by the patient.



Although patient had a moderate smile line, consideration was given to artificial gingival architecture using pink porcelain for an improved overall aesthetic.

Zirconia bridgework direct to fixture head
Fitting surface of the six zirconia abutments






One month in function post op.

The lower arch full implant supported bridgework to follow in near future.





5 years post op.

Stable bone levels and implant integration maintained support for the fixed maxillary (upper) bridgework. Patient has maintained 4‐6 monthly maintenance review and hygiene visits.

5 years post op. Complete the upper arch Fixed Hybrid Zirconium frame porcelain bridgework.

Patient has now decided that lower teeth that are now terminal require replacement with implant supported bridgework. Note the extent for bone loss on the lower arch.





5 years Post Op, Lower arch with terminal dentition above. Immediate implant placement and all‐on‐6 immediate implant supported fixed bridgework. Patient walks away with fixed lower bridgework.



Immediate Implant Placement and Provisionalisation: mandible

5 years Post Op



The lower implants now integrated and ready for final fixed bridgework issue. Implant placement in the anterior mandible entails low surgical risk and high restorative predictability. (Kopp CD:Brånemark Osseointegration: prognosis and treatment rationale. Dent Clin N Amer 1993;33:701‐731)





Further fixed full mouth bridgework please refer to menu Immediate Implant teeth All On -6 Implants MAXILLARY AND MANDIBULAR & Dental-facial Rejuvenation Full Mouth Rehabilitation.

All above procedures were performed by Dr Sarkis Nalbandian.

Education and Experience are everything.

Designer Smiles® is a one stop shop for most implant, surgical and reconstructive (prosthodontic) oral rehabilitation solutions.