Nothing to hide any more...

When the patient first time arrived to us asking if we could improve her smile, so she should not need to hold her hand in front of her mouth when smiling, and we said, well, we can do the trick for you, she was so happy with the quick and reassuring answer of our dentist, that with the next smile, she even forgot her tooth covering reflexes. Well this is how the treatment started…

During the consultation it turned out that some of her dental caries was so deep that even the nerve chamber of some of her teeth were involved…She was indeed complaining for years of sensitivity and recurrent pains of her teeth…to avoid further problems she needed also some root canal treatments and fillings to avoid recurrent infections and pains. Only after the cleaning of the dental cavities and caries we can make the root canal treatments, fillings and the necessary preparations for crown and bridgework.

Unfortunately some of her teeth were too bad for salvage and we had to remove them. To have enough posts for fixed bridgework, she needed some implants also. As she was missing many teeth for decades, she had also major bone resorption, thus she needed also sinus bone augmentation (bone graft to sinuses) during the implant surgery.

Following the healing of the implants we used two types of crowns and bridges: to the upper front she got Procera crowns, to the lower jaw she got gold ceramics.

As we could not use immediate loading 3 months had to be waited for the full healing of the lower implants, but as we can see it was worth the patience...

Before implantation

After implantation

Nicely in order

Although our 21 year old patient had healthy teeth he could not accept their look. In his everyday life he felt timid about his teeth, smiled only with closed lips, spoke with lips hardly apart. He wanted to have orderly, symmetric and beautiful smile.

We suggested orthodontic treatment, but the patient wanted to have a quick solution and could not tolerate the idea of 1-1,5 year pleasure of fixed orthodontic appliances in his mouth in his age. For this reason he waned the expert opinion of our dentists.

According his panoramic X-ray (OPG) our experts suggested him to have all his four wisdom teeth removed, as there was a size discrepancy between the size and number of his teeth and size of his jaws. His wisdom teeth also contributed to a certain amount of his crowding of his anterior teeth.

Under general anaestehsia he underwent the surgical removal of his four wisdom teeth in our department. He also had a gum plasty of his upper right and left lateral incisors to increase the length of these crowns for a more esthetic gum level.

He also needed root canal filling to manage the angular difference of his tooth. Following the preparation of his teeth for crowns he got temporary crowns right away before he left our department to protect the prepared teeth and keep the esthetics.

On the patients special request we prepared the final crowns from metalfree special circonium, full porcelain (Procera) material, which gives today the best aesthetic (transparency!) and functional solution in the world.

Before treatment

After treatment with procera crowns

A new smile

Our patient came to us with moving teeth, that were beyond all professional possibilities to stabilize and save due to progressive end stage paradontal disease and bone loss. Due to her social status she really wanted to have a beautiful smile provided by fixed bridges, instead of removable dentures. Most unfortunately we really had to remove her teeth as her status was obvious looking at her original OPG. Thus she really become edentulous (without any teeth) when we embarked to reconstruct her smile.

Before implantation procedure

Our oral surgeon performed bone augmentation (Onlay and sinus lifts) with 9 implants into her upper jaw and 5 implants were placed into the mandible. Following the implant placement and healing we took the impressions, checked the metal basis and finally we fixed the new bridges.

Great care was taken, that the new crowns should provide the high demand esthetics with their natural forms and sizes, which taken into account the high degree original bone loss, was enhanced by using pink/ gum colored ceramics to keep the length of the crowns within the demands of the final esthetics.

X-ray views of the osteointegrated implants, the screws fixing the bone blocks are also visible.

Lower and upper implants

With Branemark bridge

After dental implantation procedure

Esthetics and functionality

Our 51 year old patient arrived to us with missing teeth, old fillings and crowns, extremely worn teeth (abrasion). He needed full mouth rehabilitation. Thus unfortunately we needed to prepare all his teeth.

Before treatment

Upper and lower bridge

The process of dental treatment

The treatment was basically divided between the upper and lower jaw. We started with the upper. As he had anterior cross-bite, we had to make root canal fillings. Then the patient received a full upper bridgework, to set the right bite, the right facial height and also to train the temporomandibular joint for bite raising purposes.

He had dental implants in the region his missing lower molar regions. Following the osteointegration of these implants we could prepare the lower fixed porcelain bridgework.

After dental treatment

Our patient was perfectly happy with the result as it was not only esthetically pleasing, but also his bite was functionally restored.

Impossible? A word not existing in our library...

This patient of ours was delaying definitive reconstructing works on his teeth for decades, for the reason of fear. He was afraid of a long serious of painful and long dental procedures when the whole would start. Nevertheless after a long time eventually convinced by his wife, he embarked on the treatment. Despite his age being worried as a child he finally forced himself into our dental chair. Fortunately following a long consultation when he got answers to all his questions his fears grossly reduced and eventually started the treatment with full confidence.

Before first implantation treatment

Before second implantation treatment

Fortunately in this gentleman’s medical history there was nothing serious noted that could contraindicate our dental and surgical plans. He had only vague history of allergic reactions to penicillin in the past.

As you can see our patient arrived with eight missing teeth in the upper jaw and we also had to remove one additional tooth.

As a next step we performed bilateral (both side) sinus lifts (bone augmentation to the sinuses e.g. between the bony floor of the maxillary sinus and the elevated sinus membrane) together with placing 7 implants into the upper jaw. As he was missing his molars and premolars in his bottom jaw with no tooth in the far end (free and no possibility to prepare a conventional bridgework) we implanted 2-2 Camlog implants to both sides to reconstruct the basis for posterior molar support.

We also had to remove the mobile lower left central incisor (31) which had major paradontal disease.

The patient got a long term temporary bridge for the lower jaw and a temporary removable prosthesis for his upper jaw for the healing period. In 6 moths time we met again when the final, definitive dental work started.

As a general good state of his upper right 7 (17) lower left 3, 4, 5 (3,4,5) and lower right 3, 4,5 (43, 44, 45) they did not need any dental work.

We have chosen the shape and color of the crowns according to the patients age and remaining teeth for a more natural look.

After implantation

An uncompromised smile

X-Ray before treatment

You can see on the orthopantomographic X-ray (short OPG) the end stage paradontitis, with major bone resorption around the existing teeth, which in turn make all teeth instable, mobile, impossible to function well in chewing, biting, not to mention esthetics and pains. (Bone level is approximately at the tip end of the roots)

Our patient had this X-ray (above) when he first arrived to us for a consultation. A through look on the OPG makes it clear that it is impossible to reduce inflammation, stabilize or save any teeth.

Unfortunately we had to remove all remaining teeth to fight against infection and further bone loss. 3 months following extractions the patient had simultaneous bilateral (left an right sided) sinus lifts together with the placing of the implants. 10 implants were inserted into the maxilla and 8 to the bottom jaw the mandible.

X-Ray after dental implantation process

For the healing periods the patient was wearing removable dentures.

Following the osteointegration – the healing of the implants started definitive dental rehabilitation. We constructed the upper and lower bridges to stabilize not only the occlusion but also the original facial height and of course to provide the best possible esthetics. Bearing in mind the considerable amount of lost bone height due to the original paradontal disease, to avoid the excessive crown length we kept the esthetic crown length and used pink/gum colored porcelain above the crowns for the best possible esthetics.

The final result is, as you can see, the uncompromised smile…

Implant supported crowns, stable function, chewing, natural smile, self confidence.

After dental implantation

The importance of smile

Our patient, who was extremely self consciousness not only about his appearance with his clothing, but also about his teeth, wanted to improve his smile with even more esthetic upper front teeth.

As he was having previous dental rehabilitation with porcelain shells, we just had to remove them, thus there was not necessary to file even more material off his teeth, during the preparation. We choose the best, the optimal solution. With porcelain shells we can nevertheless improve only minor esthetic irregularities, with optimal bites. We can not recommend this solution for heavily filled and discoloured teeth neither for those with edge to edge bites.

He had special treatment for the gums. During the technical preparation of the final shells the patient got temporary shells, which is a practical solution as they easily last for a couple of weeks without the danger of loosing them and there is no real esthetic confidence ruining appearance during this period.

In five days the new porcelain shells were prepared by the dental laboratory and they were fixed with a special way. Not even the trained eye can tell sometimes the difference between a patients own and porcelain shells. The transition between the original to shells is unnoticeable.

Before sinus lifting

Branemark implants

After sinus lifting and implantation

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