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...

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.

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.

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.

Esthetics and functionality

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

An uncompromised smile

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.

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.

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.