This patient presents in his early 80’s and complains that his existing removable prostheses, which he has had for less than 1 year, are not functioning properly.
Initial esthetic evaluation demonstrates imbalances in both color and position of the existing front teeth.
View of the upper jaw with partial denture prostheses inserted and removed. One implant is visible on the patient’s right with an attachment to help retain the upper prosthesis. The patient’s left front tooth is also a dental implant currently holding a single crown. Close clinical examination followed by exploratory excavation, reveals unrestorable decay and structural failure of the surrounding front teeth.
View of Lower jaw with partial denture prosthesis inserted and removed. Two implants with denture attachments are visible on both sides, which are used to help retain the lower prosthesis. Decay and wear is noted on the front teeth, and a missing crown for the molar on the patient’s right side.
Improper design of both the upper and lower prosthesis, as well as imbalances in the bite, are the major reasons why these prostheses are not as serviceable as the patient desires. Pre-existing decay and structural compromises with the other supporting teeth have also contributed to treatment failure. After consultation with the patient and addressing his expectations for future treatment, the definitive treatment plan was formulated. This would include extraction of all remaining natural teeth, and placement of one additional implant on the upper jaw, and two on the lower. The 3 total implants on the upper arch would then be used to support a removable implant prosthesis, and the 4 implants on the lower would be used to support a full arch fixed implant bridge. In the interim healing period of 4 months the patient wore an immediate upper denture and his existing lower implant supported partial denture, with teeth replacing those which had been extracted.
Smiling photo with the upper immediate denture and lower immediate converted partial denture in place the day of the extractions and implant placement.
Photos of the lower existing implant partial denture prosthesis before and after immediate conversion was done to replace the now missing front teeth. This was a very inexpensive way to give the patient the best possible function during the healing period, because this prosthesis already contained all of the necessary hardware to attach to the two existing lower implants.
Frontal photo of the interim healing prosthesis in place.
This is a photo of the new upper removable implant prosthesis. Because the 3 implants were well spaced, and the patient had ideal upper jaws anatomy, the palate portion (roof of the mouth) can be left open to allow the patient more tasting sensation when they eat. This represents a huge advantage over a conventional denture.
This photo of the upper jaw shows the 3 implant attachments used to help support and retain the patient’s upper removable implant prosthesis. Typically 4-6 implants are required to support a prosthesis that is plateless. Because 2 of the 3 implants were pre-existing and successfully utilized for roughly one year’s time, in combination with their very ideal spacing, and patient’s ideal jaw anatomy, the exception was able to be made for his situation.
This is a photo of the removable implant prosthesis for the upper jaw. The red circles are the attachments that hold the prosthesis to the implants. Metal reinforcement is required for this prosthesis design because the patient is able to generate much higher biting forces than would be possible with a conventional denture, which increases the chance of fracture of the prosthesis. This metal also provides very intimate contact with the gum tissue as well as extra rigidity, which is very important in this patient’s particular case because only 3 implants were used.
This photo shows the lower full arch implant bridge in place. This bridge is fully supported by the 4 implants on the lower jaw, and is connected with screws and retrievable cement. This allows the bridge the opportunity to be easily removed by the dentist in the future if maintenance issues should arise.
Final prostheses in place on the upper and lower jaws.
Pre and post treatment frontal mouth photos.
Because removal dental prosthesis is always recommended at night, and this patient was able to make contact between the upper implant attachments and the lower porcelain bridge, a plastic night guard was made to prevent damage, should he attempt to grind during sleep.
Before and after radiographs demonstrating the new implants and prosthetic hardware.
Smiling photo with final prostheses in place.
Full face photo of the patient with the final restorations in place!
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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!