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Designer Smiles Dentistry

Why Do We Need Bone Graft for dental implants? Case Study

When we lose teeth we also inevitably lose bone. The loss of bone is more pronounced on the focal aspect rather than on the tongue side. The problem is that most front teeth are positioned on the facial aspect that makes your smile appear natural This is ok when you have a low smile line that is when you smile you don’t show your gums.

Why Do We Need Bone Graft for dental implants? Case Study

When we lose teeth we also inevitably lose bone. The loss of bone is more pronounced on the focal aspect rather than on the tongue side. The problem is that most front teeth are positioned on the facial aspect that makes your smile appear natural This is ok when you have a low smile line that is when you smile you don’t show your gums.
Model

Why Do We Need Bone Graft for dental implants?

Case Study

When we lose teeth we also inevitably lose bone. The loss of bone is more pronounced on the focal aspect rather than on the tongue side.

The problem is that most front teeth are positioned on the facial aspect that makes your smile appear natural

This is ok when you have a low smile line that is when you smile you don’t show your gums.

However when you have a high smile line (gums showing) then we can have problems with aesthetic outcome and refer this situation as an aesthetic risk assessment.

You see teeth implants are not teeth. Teeth have taken millions of years to be evolved. Implants are artificial devises that we place in the bone and allow integration.

Therefore it is essential to place implant in correct 3 D in the bone to allow natural tooth emerging through the gums. This is most difficult even for experienced specialists; however we all do our best to make it look right

Ms. E. was referred by her sister existing patient for specialist evaluation. After attending her general dental practitioner, Ms. E presented with recently extracted upper right first premolar. The extraction was traumatic and unfortunately the facial bone was removed at the same time. The dentist unfortunately with minimal experience trying to provide provisional bridgework unnecessarily cut good adjacent two teeth.

I summary we have the following problems;

  1. Loss of biology- ruthlessly cutting unrestored healthy teeth! Tooth 13 upper right canine tooth is now symptomatic!
    this is indefensible
  2. Traumatic extraction: loss f large chunk of facial bone causing horizontal and vertical defects
  3. High smile line with large facial defect
  4. Traumatisedapprehensive patient!

This dentist should have sought a specialist opinion prior to extraction of tooth 14. As specialists we are trained in atraumatic extraction and know how to make non invasive provisional bridgework. The ignorance and arrogance of inexperienced dentists is a concern that all specialists and experienced general dentists share.

High smile line: The defect is clearly visible and most upsetting for this post graduate university lecturer and practicing lawyer.

How do we fix this problem?

Treatment: 3D planning using CBCT (cone beam Ct) and diagnostic planning that included

  1. Extent grafting required and 3D implant position
  2. Providing improved provisional bridgework to restore Ms. E’s confidence and reduce apprehension

This study will show

  • Complexity of treatment. Hence specialist intervention is required as precise outcome is critical
  • Treatment outcome
  • Patient’s assessment
  • Please refer to the video provided
INITIAL PRESENTATION

Patientpresented with otherwise healthy dentition. Now the cut tooth 13 was painful. There was no need for provisional crown placement o teeth 15 & 13 condemning healthy teeth to future restorations.  Unfortunately tooth 13 developed an abscess and required a root canal therapy. Patient should have been informed and specialist’s opinion sought.

Chief concerns:

  1. Pain on tooth 13.
  2. Food impaction in the extraction site defetc
  3. Speech concerns as the provisional bridgework was impinging I her tngue
  4. Aesthetic defect affects the quality of life of Ms. E
step
1
DIAGNOSIS

Diagnosis: Female patient presenting with traumatic tooth extraction and poor provisional bridgework that is creating discomfort and aesthetic disturbance.

Aesthetic defect

Our Aim:  Control pain, site augmentation to allow correct implant placement and replacement of missing toot 14. Provision of new ceramic crowns on teeth 15 & 13. Improve the aesthetics of upper arch: tooth shape, display, tooth colour, length, symmetry and smile line in general along the upper arch

This was accomplished with minimal discomfort to the patient over 8 months. Yes it takes time and there are no shortcuts!

step
2
TREATMENT

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

No treatment: this is not an option as this is an aesthetic defect that affects the quality of life of Ms E, she is Lawyer and lecturer and most conscious of her smile and speech impediment

step
3
PROCEDURE & RESULTS

The work was completed in 8 months. Using simultaneous site augmentation and implant placement.

Ms. E was happy with the aesthetic outcome.

We made no guarantees that this aesthetic result would be achieved and Ms. E was informed and understood the limitations placed on the clinician. As a specialist I always do my utmost for the best possible outcome.

Step
4
What our Clients Say!

I've been a customer of Designer Smiles for over 20 years and I cannot say enough good things about them! From the moment you walk into the office, you are greeted with a warm and friendly atmosphere that immediately puts you at ease. The staff is knowledgeable, professional, and caring. They use the latest technology and take the time to explain everything. I highly recommend them!

Ken Baumli

Dr Sarkis is the maestro of cosmetic dentistry….for years I suffered with 2 slightly darker front teeth due to a childhood accident. I’ve had composite veneers before but nothing compared to the composite veneers Dr Sarkis did……now I feel so confident smiling again……Dr Sarkis I can’t thank you enough…

Monica McKenzie

Quite literally the best dentist I’ve been to in a lifetime. Dr Natasha Koelmeyer specifically is just a wonderfully kind and gentle Doctor. Must also mention that the head specialist here is also second to none. Their knowledge (goodness they know their stuff) their approach, their kind and gentle manner - my daughter actually enjoys going to the dentist. They’ve got a really considered patient centric mentality. I wouldn’t go anywhere else, every single person there including the reception staff is a star. Thank you Designer Smiles!

Michelle Lacasse

My journey with Dr Sarkis began about 10 years ago. I did not realise that I had lacked self confidence and shone away from "my true smile". Dr Sarkis was honest, reassuring and professional throughout my process and not only was he able to achieve that perfect smile but achieve same without compromising the health of my teeth and gums.The ongoing care at Designer Smiles is 5 star whether it is a routine check, clean minor or major dentistry. Thank you Dr Sarkis and also your team.

Christina Vergotis

I found Designer Smiles from one of their YouTube videos showcasing the Icon treatment to fix white spots on teeth. Dr. Sarkis Nalbandian's consultation provided me with a thorough plan and showed me how their practise could give me predicable results for my concerns. I knew I was in safe hands. I had Kristy Gupta perform both of my procedures and she was very professional and so kind. I am very happy with my results!

Winsome Kain

I cannot express how grateful I am for Sarkis and the team at Designer Smiles. Around 11 years ago my life changed when Sarkis first transformed my smile with composite veneers. This month, with my original teeth in tact I returned to have my composite veneers upgraded to porcelain. I was amazed that Sarkis and his team could do this without an injections, no pain and whilst still keeping my original teeth in tact. I absolutely love the result and I would highly recommend that anyone that is unhappy with their smile in any way, must visit designer smiles

Matt Williams

Started my treatment with the team at Designer Smiles in 2019. Had other dental treatments including Maxillofacial, expanders, straightening and gum grafting but out of all the procedures and surgeries Dr. Sarkis was the key as he was applying the ‘finishing product’ which included composite veneers. I am gobsmacked by the incredible job done. He talks the talk and definitely walks the walk. And his support team there are simply incredible and make you feel part of a family not just another dental clinic to take your money. Can not recommend highly enough. Customer for life here!!

Shaun Meader
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