Implants Replaced Crowns
Implants Replaced Crowns
Old Bridge & Crowns Replaced by New Crowns & Implants – Patient Story
This patient had severe failing crowns and bridgework which affected her comfort, the function of her mouth and the aesthetics of her smile. This was further compounded by the presence of high smile line.
Her treatment involved reconstruction of the upper teeth arch (maxilla) using tooth supported, and implant-supported, crowns and soft and hard tissue grafting (site augmentation) where teeth have failed that require removal.
This study will show the following;
- Complexity of treatment
- Treatment outcome
- Patient’s assessment
- Please refer to the video provided
The patient was referred by her dentist, seeking a dental specialist's opinion and treatment concerning the fixed option of restoring missing teeth and failing dentition. The patient being a past model, had difficulty adapting to his current upper denture/plate. He also retained his lower teeth for fear of wearing a complete lower denture since the upper denture was unsuccessful.
Most of the time, the upper plate was in the patient's top shirt pocket, only used to chew his food, affecting his confidence in his profession.
We have unacceptable aesthetics and function. It's surprising to see how much patients can tolerate broken-down dentition. We all are busy in our lives, looking after the family, and finally, when everyone is ok, it is time for us.
Note Upper arch: edentulous and lower arch with broken-down dentition and crowns.
Our chief concern in this case was improving the aesthetic appearance of the patient’s smile. To improve the upper teeth arch shape and smile line, as well as teeth colour. She wanted to smile and chew her food confidently. She was specifically concerned about recent dental work, by another dentist, causing protrusion and canting of her upper central incisors creating an aesthetic disturbance, lip incompetence and a speech impediment.
You can see the ridge defect in the critical aesthetic zone, currently replaced by provisional removable prosthesis. This site required surgical augmentation prior to implant placement. This allows implant to be placed in the correct dimension for optimal construction and emergent profile of the final crowns and bridgework.
His aesthetic and function are unacceptable: teeth, fixed restorations and poor adaption to existing upper inadequate dentures.
Our aim: is to improve the aesthetics of the upper arch: A new denture correctly constructed for patient comfort speech, followed by implant-supported fixed lower bridgework construction.
We usually construct a well-fitting and aesthetic denture in patients with maladaptation to upper dentures. If this is satisfactory, there is no need for further treatment with implant and fixed bridgework. However, for those few patients who cannot adapt to the new upper denture I tried, the next option is to consider upper (maxillary) fixed implant-supported bridgework.
This was accomplished with minimal discomfort to the patient, and he left the practice without teeth: the new maxillary denture and lower temporary bridgework as both aesthetic and functional.
This was accomplished with minimal discomfort to the patient and she left the practice with teeth in her mouth for the duration of the treatment. The provisional bridgework was both aesthetic and functional.
Following a discussion of all risks and treatment modalities with our patient, it was known that:
- Treatment: this is not an option, as the restorations are failing and affecting the longevity of supporting teeth
- Option: implant-supported upper and lower fixed bridgework-assuming there is intolerance to an upper denture
- Provision of the new upper denture as the patient can adapt and construct new lower implant-supported fixed mandibular(lower arch) bridgework) and accepted by the patient
The work was completed in six months as it takes this long for grafts (bit longer) and implants to integrate with bone. Is best not to rush biology and allow optimal healing.
Construction of aesthetic and well-fitting maxillary complete denture, followed by immediate provisional (ISFDP) implant-supported fixed bridgework as the lower teeth are removed, and the temporary bridge was constructed within a few hours on the day of the implant placement.
Lower arch: Immediate provisional (ISFDP) implant-supported fixed bridgework as the lower teeth are removed and the temporary bridge constructed within a few hours on the implant placement day.
Unfortunately, this work was initially completed by a dentist with minimal qualifications and experience. Hence the reason for the patient seeking a specialist prosthodontist for correct diagnosis and treatment planning; providing an optimal outcome for her.
The final treatment outcome: The function, comfort and aesthetics have been restored. More importantly, her facial aesthetics compliment her new smile.
Hence the term: dentofacial rejuvenation
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