Multiple missing teeth-Oligodontia (missing teeth from birth).

Patient presented with multiple missing teeth on both jaws(Oligodontia, where six or more teeth are missing that never erupted in the mouth). This is a high aesthetic zone and quite a difficult case. Note high smile line, where teeth on the both arches are on the show.

Placement of three implants on upper jaw supporting four missing teeth and two implants on lower jaw to support six missing teeth. Patient wears a partial denture that is causing discomfort, during function and phonetics, not to mention poor aesthetic presentation that has haunted this lovely patient since childhood, affecting her confidence.

Critical planning & assessment is required.


Complex aesthetics Reconstructive procedures: case study

Dental Implant: multiple missing teeth-Oligodontia (missing teeth from birth).

Patient presented with multiple missing teeth on both jaws (Oligodontia, where six or more teeth are missing that never erupted in the mouth). This is a high aesthetic zone and quite a difficult case. Note high smile line, where teeth on the both arches are on the show.




The aim is to maintain her gum architecture and “fit” the teeth on the gums to create a natural emergence profile, as if the implant supported tooth is growing out of the gum. Careful planning and understanding of all biologic-aesthetic parameters are required to biomimetics: biologic-aesthetic integration whenever possible.Naturally we cannot control biology, but critical implant positioning and aesthetic planning helps the aesthetic integration.



Risk assessment:

High smile line, difficult with implants to always achieve optimal aesthetics
Patient has good oral hygiene
Regularly attends her recare visits at the dentist
Good bone support
Thick gingival biotype: this helps to form the nice madding – the gums around the implant crown.
Both arches and the gums are on the show
Non smoker



-Implant
-Restorative
-Correction
Complex Smiles Require Simple Solutions




Implant crowns: direct screw to fixture





The metal surface is placed to provide an optimal bite platform.

The screw holes are covered with tooth coloured filling material.



X-rays showing the position of the implants in the upper jaw with optimal bone support.

In summary, prosthodontics requires the training and qualification to deal with complex dental health problems. Dr Nalbandian has attended an internationally recognised and formally structured university program to give him the extra skill and knowledge required to plan and manage complex dental problems. The qualification takes several years of training and practice. This has been over 7 years of post graduate University training, multiple examinations etc. For instance, rather than simply providing cosmetic solutions, which after all, only focus on “how things look”, he is trained to correctly diagnose and treat any underlying problems beforehand. This concept is carried over into all aspects of reconstructing or improving smiles and appearances, including fixed or removable teeth, giving the patient a long-term result rather than a “quick fix” which might break down early or even damage the teeth. The implant surgery involves additional skills obtained for surgical planning and placement of dental implants as an overall diagnosis and treatment for our patients. To gain any formal post graduate qualification, one must have their relevant knowledge tested in any examination or pass any professional critical review process at world class universities.

Restoring the anatomy: mimesis-imitating nature (Aristotle)



We have improved

Lip Outline

Gum Symmetry

Tooth Proportions

Central Incisal Dominance

Smile Line




Note how the implant crowns emerge from the gum.We not only have the implants integrating with the bone but we have achieved an aesthetic Integration.




This is the panoramic x‐ray of the completed upper and lower implant supported restoration.



Planning for success is not always simple and depends on the dentist, patient and most importantly the BIOLOGY.">




Complex Aesthetics: Simple Treatment



Pleasant aesthetic achieved for this beautiful patient. The Bride is Ready Aesthetics using implant supported restorations (crowns and bridges) is not simple when restoring the Stomatognathic System (The Mouth), but not impossible!

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.