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.
