Case Study 11: Upper Implant Reconstruction

Treatment Process

This patient is a female in her mid 70’s. She has a previously fixed reconstruction on her upper jaw, consisting of a 13 unit bridge which is all connected and is anchored by only 6 teeth. She presents with the concern that one of them is “rotten”. Esthetic diagnosis demonstrates some imbalances in her smile relating to tooth proportions and contours. The most obvious being, that the front teeth are too short relative to the adjacent teeth.

From a profile view, the patient’s front teeth are inappropriately flared outward, giving an unnatural appearance.

The front teeth are all pontics (fake filler teeth) in between those which are holder teeth for the bridge. Because there are no natural teeth in these areas, bone and tissue resorption has occurred. Looking at front teeth near the gum portion is an obvious giveaway that the teeth are fake because the teeth do not appear to be “emerging” from the gum. There has also been some repair done as a result of some broken porcelain on one of the front teeth. On the lower jaw, the patient is missing most of her back teeth on both sides. To replace these, she has a removable overdenture which is supported by the remaining teeth. The patient wishes for amore permanently fixed restoration if possible, or some extra support from dental implants.

View of the upper jaw shows the existing restorations which have been in place for roughly 20-30 years.

View of the lower jaw shows the existing teeth/restorations. It is important to notice that there has been considerable resorption of the lower jaw in the locations where teeth are absent, especially on the right. This is a very typical finding for a patient who has been wearing a removable prosthesis (either a partial denture or a full denture) without implant support. Jaw bone will naturally resorb when teeth are removed. This resorption is accelerated when a prosthesis is placing pressure through many years of use. The presence of dental implants in the jaw will support and retain the prosthesis will lessen the burden on the jaw bone.

This panoramic x-ray shows the upper fixed bridge which is supported by only 6 teeth. On the left side of the image (patient’s right side), 2 of the supporting teeth demonstrate the formation of root canal abscesses. Clinical exam reveals large lesions of decay on these teeth rendering them unsalvageable. The remaining teeth did show some preliminary signs of breakdown around the bridge margins, but were salvageable. In light of the above findings, the existing prosthesis could not be salvaged with a long term prognosis. Since the three teeth on the patient’s upper left jaw (right side on the image) were still serviceable as well as the backlist tooth on the upper right jaw, the patient was presented with the option of strategic placement of dental implants to support bridges, in the area of missing teeth for the upper jaw. For the lower jaw, options were discussed with regards to replacement of missing teeth. Because the patient’s bone loss was so advanced, bone grafting procedures specific to addressing this patient’s condition on the lower jaw, would be very expensive and somewhat unpredictable. As a result, the patient opted to just replace the missing lower teeth with a new partial denture.

At the time of tooth removal, some bone grafting was done in the areas where an adequate quantity of bone was not present  to support dental implants. After several months of healing, 5 dental implants were placed. During the healing phase, the patient wore a “healing” partial denture to replace the missing teeth, and temporary restorations were provided for the other teeth that were saved.

View of the final titanium posts (called “implant abutments”) for which the porcelain bridges will be cemented on.

Final bridges in place on the upper jaw.

View of the new removable partial denture in place on the lower jaw. Special crowns called “survey crowns” were placed on the 3 of the existing teeth. These crowns are unique in that they have built in features that help support and retain the partial denture. Use of surveyed crowns often dramatically improves the serviceability of a partial denture, and leads to higher patient satisfaction.

View of new bridgework and removable partial denture in place. Notice the small gold “hooks” (called clasps) extending from the partial denture. These clasps are important for providing retention for the partial denture. However, they were designed to engage to the surveyed crowns low enough to not be seen when the patient smiles.

Lip at rest photo with the final bridges in place. The patient shows several millimeters of her front teeth when her lip is at rest, and this appropriately gives a more youthful smile.

Smile photo with final bridges in place.

Missoula top teeth implants

Comparison of panoramic x-rays, before and after treatment. Make notice of the 5 dental implants in the after x-ray, which provides much better dental support for the teeth in that segment, for an excellent long term prognosis. 

Before and after intraoral photos of old vs. new bridge work. Notice that the new front teeth seem to “emerge” more naturally from the gum tissue. The patient also used whitening (bleaching) trays to lighten her natural lower front teeth, allowing the new bridges and partial denture teeth to be lighter color. Lighter teeth (within reason) also helps provide a more youthful appearance. 

Before and after full face smiling photos.

Full face smiling photo. The patient was very happy with the appearance and function of her new teeth!

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At Meng Dentistry we welcome all dental patients including those needing more complex dentistry. We provide the full range of Prosthodontics, cosmetic dentistry, and general dentistry including, teeth whitening, esthetic bonding, dental veneers, crowns, bridges, removable prostheses (dentures and partials), maxillofacial prosthodontics (obturators), and dental implants. Call today to see how Meng Dentistry can transform your smile!

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