Porcelain Veneers

Smile Makeover

CAID Cosmetic Dentistry Smile Makeover 108

CAID Cosmetic Dentistry Smile Makeover 102

This lady presented to us seeking a total smile makeover. What bothered her most about her smile was the crooked splay in teeth and all the gaps.
The teeth were structurally sound and the gums in good health. Orthodontic treatment was considered, but apart from the lengthy timeframe of the treatment, this would not have fixed the shapes and sizes of the teeth.
We decided on Porcelain Shell Crowns and treated all the peer teeth, and only the right canine and premolar, which were previously in cross-bite, to achieve the desired smile makeover.
Porcelain Shell crowns when planned correctly and executed meticulously, can offer a remarkable result due to the light transmitting qualities, similar to porcelain veneers.

CAID Cosmetic Dentistry Smile Makeover 101

CAID Cosmetic Dentistry Smile Makeover 107

Porcelain Shell Crowns restore the aesthetics by resurrecting the shapes of the teeth to be straighter and close the gaps.

Smile makeover with Porcelain shell Crowns for crooked and gappy teeth

CAID Cosmetic Dentistry Smile Makeover 116

CAID Cosmetic Dentistry Smile Makeover 104

This patient wanted a smile makeover. He didn’t like the gap between his upper front teeth and their rugged and worn appearance.
We treated this case with Porcelain Shell Crown to the upper front six teeth. This was sufficient in order to achieve the aesthetic outcome that this patient always.
This method is very similar to Porcelain Veneers and require less tooth preparation than standard dental crowns.
The teeth are prepared by filing them down approximately 0.5 to 0.75mm, as seen in the second sequence picture.
The shell crowns are made in our onsite laboratory and are bonded to the tooth with a light cured cement.
The shell crowns have a level of transparency allowing light transmission that mimics a natural tooth, as see in the 4th and 5th picture in the sequence.
The end result is closure of the gap and the smile makeover that the patient always wanted, and which is also conservative.
At this clinic we pride ourselves on being able to ascertain the most efficacious approach to achieve the desired result in any smile makeover without compromising on quality, and it may not necessarily be quite as complex or expensive a treatment as patients often anticipate.

CAID Cosmetic Dentistry Smile Makeover 105

CAID Cosmetic Dentistry Smile Makeover 112

The teeth are prepared by filing them down 0.5mm to 0.75mm.

CAID Cosmetic Dentistry Smile Makeover 111

Porcelain Shell Crowns are made very thin similar to veneers.

CAID Cosmetic Dentistry Smile Makeover 114

The Shell Crowns are cemented and set in place with a special light.

CAID Cosmetic Dentistry Smile Makeover 113

Like Veneers, Porcelain Shell Crowns have optimal light transmitting qualities.

CAID Cosmetic Dentistry Smile Makeover 117

Smile Makeover with Porcelain Shell Crowns

Oral Rehabilitation

CAID Cosmetic Dentistry Oral Rehabilitation 106

CAID Cosmetic Dentistry Oral Rehabilitation 107

This young man had lost some back teeth over the years. He also grinds his teeth at night during sleep. As a result, of not having back teeth to support his bite, the front teeth were taking the grunt of the load and had severe wear causing his bite to collapse.
Oral Rehabilitation involves the restoration of the teeth to their correct height and to restore the vertical dimension of occlusion (in other words the bite) to where it should be.
We achieved this with porcelain crowns to all the teeth, and bridges where we had to replace missing teeth.

CAID Cosmetic Dentistry Oral Rehabilitation 104

CAID Cosmetic Dentistry Oral Rehabilitation 101

CAID Cosmetic Dentistry Oral Rehabilitation 105

CAID Cosmetic Dentistry Oral Rehabilitation 102

CAID Cosmetic Dentistry Oral Rehabilitation 108

This close-up illustrates the heavy wear of the teeth and the ongoing breakages of the fillings

CAID Cosmetic Dentistry Oral Rehabilitation 109

Crowns made from a strong porcelain material restore the shape/colour of the teeth and protect each underlying tooth.

Oral Rehabilitation with Porcelain Crowns to correct tooth wear and collapsed bite

CAID Cosmetic Dentistry Gum Lift 110

CAID Cosmetic Dentistry Gum Lift 107

This young man came to us because he didn’t like the appearance of his teeth. Whilst the teeth themselves can be improved with a variety of dental treatments, the main issue here was the asymmetry of the gum line and the gingival excess in the upper lateral incisor area.
Before improving the appearance of the teeth themselves, in order to achieve a more balanced choreography of the gum line we undertook a Gum Lift procedure. After allowing 8 weeks for the new gum line to stabilise, our cosmetic dentists fitted porcelain veneers to the front four upper teeth to complete the smile restoration.
Cosmetic Dentistry is not just about making the teeth look better. When assessing our patients at Centre for Aesthetic and Implant Dentistry we always look at the entire smile design, including the gum-line, in order to achieve the most optimal aesthetic results.

CAID Cosmetic Dentistry Gum Lift 108

Uneven tooth edges and too much gum around the lateral incisors

CAID Cosmetic Dentistry Gum Lift 111

Gum Lift to the lateral incisors and Porcelain Veneers to the four front teeth to restore balance.

Gum Lift and Porcelain Veneers to correct gingival imbalance

Gum Lift

CAID Cosmetic Dentistry Gum Lift 104

CAID Cosmetic Dentistry Gum Lift 102

Excessive gum display can cause people to feel embarrassed to smile, such was the case in this young lady. Here the problem was an over-development of the maxillary jawbone, which caused a gummy smile and the teeth appearing too long.
In certain situations it is possible to provide improvement with braces and orthognathic (jaw-correcting) surgery. However in this case the patient declined this course of treatment and wanted a quicker makeover. This was achieved with a gum lift procedure, followed by porcelain veneers to the upper front 6 teeth.

CAID Cosmetic Dentistry Gum Lift 101

This young patient didn’t like the uneven and excessive gum display that she had on smiling. The teeth appear as though they are hanging down unevenly.

CAID Cosmetic Dentistry Gum Lift 103

After the gum lift procedure, the gum-line is more symmetrical and less excessive.To achieve the correct proportions, the teeth had to be shortened and were fitted with porcelain veneers

Gummy Smile treated with Gum Lift and Porcelain Veneers

Zirconia & Porcelain Teeth Options

Porcelain Crowns

CAID Cosmetic Dentistry Dental Crowns 137

CAID Cosmetic Dentistry Dental Crowns 139

This lady presented with numerous dental issues that she had over the years. She was never happy with the appearance of her teeth, but what triggered her visit to our clinic was the broken bridge on the left.
On examination we discovered that her bite had collapsed and was not ideal for long term dental health. Her treatment involved our cosmetic dentists fitting porcelain crowns to all her teeth, which allowed us the flexibility to correct the bite and improve the aesthetics as required.
The old bridge was replaced with a single dental implant as part of the process.

CAID Cosmetic Dentistry Dental Crowns 136

CAID Cosmetic Dentistry Dental Crowns 135

Makeover with Dental Crowns

CAID Cosmetic Dentistry Dental Crowns 130

CAID Cosmetic Dentistry Dental Crowns 131

This lady had moderate crowding and was not willing to undergo orthodontic treatment (braces). She wanted a more immediate result to improve her smile, not necessarily make it perfect. She also had a limited budget.
Was replaced the old fillings with new composite fillings and used Porcelain Crowns to straighten and restore the upper front two teeth for improved aesthetics.

CAID Cosmetic Dentistry Dental Crowns 132

The teeth are crowded and show signs of deterioration and leaking fillings

CAID Cosmetic Dentistry Dental Crowns 133

Porcelain Crowns correct the crowding and restore aesthetics

Porcelain Crowns to Correct Crowding

CAID Cosmetic Dentistry Dental Crowns 110

CAID Cosmetic Dentistry Dental Crowns 101

This lady had a long history of dental treatment with numerous caps done over the years. She also lost numerous back teeth over that time and was wearing a lower partial denture.
She was unhappy with the lower denture because of the metal clasps and the constant looseness she was experiencing as well as functional difficulties. She wanted some sort of make-over to get rid of her denture and improve her smile.
In the lower the existing caps were ‘leaking’, which is a term used to describe when decay affects the root of the tooth at the margins and spreads under the crowns. We were unable to save the lower teeth and treated the lower with an implant-supported bridge.
In the upper we used porcelain crowns to improve the appearance, contours and alignment of the teeth, and where she had missing teeth in the back we used dental bridges to close the gaps.
Being able to achieve an aesthetic outcome with any dental treatment is a product of the diagnostic steps that we take, treatment planning in combination with our onsite laboratory, and our quality standards.

CAID Cosmetic Dentistry Dental Crowns 102

The upper teeth show old leaking crowns and recession exposing the roots. In the lower there is a partial denture.

CAID Cosmetic Dentistry Dental Crowns 111

Porcelain Crowns in correct the crowding and restore aesthetics, done along with lower rehabilitation with dental implants.

Old crowns replaced with Porcelain Crowns

CAID Cosmetic Dentistry Dental Crowns 114

CAID Cosmetic Dentistry Dental Crowns 107

Dental Crowns are used in a variety of situations to act as a protective cap over a broken down or heavily filled natural tooth, and to restore the shape, colour and alignment of the teeth to restore them to natural aesthetics.
There are many types of tooth caps available, but the most important determinants in getting the best aesthetic result and maintain gum healthy are the skills and aesthetic accuracy of the dentist and ceramist who makes the crowns. And just like the saying ‘beauty is in the eye of the beholder’, what some clinicians and patients accept as being ‘aesthetic’ may be quite different to how others perceive it. Thus the end result is highly dependant on the quality standards of the clinic and all the people involved in the treatment.
This patient had Porcelain Fused to Metal (PFM) crowns done elsewhere and was unhappy with their dull and grey appearance. At Centre for Aesthetic and Implant Dentistry we may also offer similar type of caps, but we would strive for better aesthetics even with the same ‘kind’ of caps.
In this case we used a different kind called All-Ceramic Crowns in order to improve light transmission and were able to re-treat the case to offer improved aesthetics.
Note that in addition to the teeth in the ‘After’ photo looking far more ‘alive’, the gums are not inflamed like in the ‘Before’ picture. Gum inflammation after capping of teeth is often caused by bulky or rugged margins on a microscopic level, and this again is one of those things that are demonstrative of the quality standards of both the dentist who prepares the teeth and the ceramics technician.

CAID Cosmetic Dentistry Dental Crowns 113

CAID Cosmetic Dentistry Dental Crowns 106

New ceramic crowns to replace poorly-made crowns

Cosmetic Dentistry

CAID Cosmetic Dentistry Porcelain Veneers 102

CAID Cosmetic Dentistry Porcelain Veneers 101

This attractive young lady presented with worn and dull-looking teeth. Her smile was ‘tired’ and flat as it did not follow a natural aesthetic curve with flattening of the teeth due to wear causing a loss of their youthful shape. We treated this lady with Porcelain Veneers to the upper front teeth and were able to restore more youthful shapes, colour depth, translucency, and natural aesthetic proportions. Dental Veneers may be used to treat a variety of conditions to restore balance, colour and shape of teeth.

Porcelain Veneers to treat flat, worn and discoloured teeth

CAID All On 4 Plus Dental Implants Melbourne 1661

CAID All On 4 Plus Dental Implants Melbourne 167

This patient received All-On-4 dental implants in 2010. The teeth that were fitted at the time of surgery were made from high impact acrylic. After 3 years in function, the acrylic material started to absorb some staining, as seen in the before shot on the left, and this patient elected to upgrade to a material that is more durable and stain resistant. The shot on the right illustrates the Zirconia teeth.

CAID All On 4 Plus Dental Implants Melbourne 186

The original teeth on presentation before treatment.

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All-On-4 Dental Implants with Zirconia-Porcelain teeth, a durable long-term solution.

CAID All On 4 Plus Dental Implants Melbourne 187

Four fixtures are visible in each jaw on this x-ray. The dense white supra-structures are the zirconia bridges.  The whiteness represents the density, which in turn reflects the durability and strength of Zirconia.

All-On-4 Zirconia Porcelain Teeth

Zygomatic Implants

CAID All On 4 Plus Dental Implants Melbourne 1771

CAID All On 4 Plus Dental Implants Melbourne 172

For this 39 year old cosmetic consultant appearance was everything. She had some old crowns and explored with her dentist options for a smile makeover. She had a couple of missing teeth and her dentist told her that the old crowns can be replaced with newer crowns, and the gaps can be filled with dental implants. He also gave her an alternative option of taking the teeth out and having full set implants, but she decided to go down the more conservative path and save whatever teeth she had left. After weeks of treatment she realised that it was not heading the way she anticipated. She became concerned by the uneven gums and dark gaps. She also developed an infection that kept recurring and gave her a great deal of pain.
She was referred to our clinic by her friend who had All-On-4 treatment at our clinic.
We removed the temporary crowns that she had to discover significantly compromised teeth and decay.
Our cosmetic and implant dentists did not share the view that the upper teeth could be saved and recommended extractions and some form of implant treatment to replace the entire upper set. This lady’s prior dentist ultimately agreed with the same.
One of the nice things about dental implants is that they are permanent. But this can also present a challenge when having to change the course of treatment. Because of their irreversible nature, they are difficult to undo. It is therefore imperative to ascertain the relative prognosis of any remaining teeth before deciding to proceed with any individual implants because the way we position them for an individual teeth is very different to how we position them for a full set replacement.
Since the fixtures were already installed in this case, they had to be removed. Apart from the defect that would be cause by the removal of the existing fixtures, there was also an infection that had spread to the bone, and the sinuses were in the way eliminating the possibility of placing fixtures in the back. Overall, the bone that was left was poor and unsuitable for a standard All-On-4 procedure.
In order to provide this young lady with a solution, we used Zygomatic Implants along with bone grafting, otherwise known as Zygoma-Plus. As part of our approach, we also performed surgical repositioning of the gum level to allow for Aesthetic Gum Replacement. The balance and gingival choreography that is achievable with this method is far more predictable than placement of multiple individual fixtures, where the appearance can be compromised by the recession of the gums and asymmetry.

CAID All On 4 Plus Dental Implants Melbourne 188

An x-ray showing failing dentition and 2 implants recently placed to replace only the front segment of missing teeth.

CAID All On 4 Plus Dental Implants Melbourne 170

What we discovered when taking the temporary bridges off. Apart from decay, there was no tooth structure left to support any sort of crowns or bridges.

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The two fixtures can be seen as yellow/gold screws partly covered by the gum.

CAID All On 4 Plus Dental Implants Melbourne 189

Zygoma-Plus Treatment After Failed Dental Work Infections

Full Set Replacement

CAID All On 4 Plus Dental Implants Melbourne 115

CAID All On 4 Plus Dental Implants Melbourne 200

The 74-year-old retiree presented with severe bone atrophy having worn dentures for over 30 years. The upper denture was loose and the lower denture was intolerable due to pain from compression of nerves that occurred with gradual bone atrophy over the years. She was not aware that there was an alternative until she saw something in a magazine and came to our clinic to determine. Before we could determine if she was a candidate we took x-rays and pictures. When our dentist took the photo (the before shot on the left) he asked this lady to smile and the upper denture was so loose that it dislodged on smiling and fell down. The picture was taken just as the denture was falling. She had the lower denture with her, but wore it in her pocket because she said it fitted better there than it did in her mouth.
As a result of severe bone atrophy that had taken place due to long term denture wearing, it was necessary to do bone grafting in the upper jaw before we could place implants to support a fixed bridge.
In the lower jaw there was marginally sufficient bone for All-On-4 implants and we were able to do this treatment using keyhole guided surgery, and fitted an immediate fixed bridge. By treating the lower, the fixed bridge helped stabilise the upper denture while the grafts were consolidating.
Once the grafts healed, we placed 6 implants in the upper jaw and fitted a permanent fixed bridge within 3-days from the surgery.
This treatment was done in 2008. Today, we have alternatives that allow us to treat patients with poor or thinning jaw bone, like this lady, with a fixed and a permanent solution within 24 hours of surgery.

Severe bone atrophy as a result of long term denture wearing. The lower denture was intolerable due to pain from the compression of nerves.

A computer-guided surgical stent (Nobel Guide) was fitted in the lower to guide the pre-planned positioning of the lower fixtures.

After the implants were placed the gums were closed with dissolvable sutures. White comfort caps were fitted whilst the teeth were being fabricated.

CAID All On 4 Plus Dental Implants Melbourne 117

An impression of the implants taken immediately after surgery was used to make a model for the construction of the bridge.

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Fixed lower replacement teeth are fabricated using highly aesthetic high-impact acrylic.

CAID All On 4 Plus Dental Implants Melbourne 199

The lower replacement teeth are fitted to the implants with tiny screws through the back and fixed in position.

Bone grafting was performed in the upper jaw and left to heal. The patient continued to wear her upper denture during the healing process.

After healing of the grafts, six dental implants were placed using Nobel-Guide computer guided keyhole surgery. Comfort caps were placed whilst the teeth were being fabricated. Note that there are no stitches with this keyhole surgical method.

In the next day, teeth were set in wax in and tried in over the implants to assess function, aesthetics, comfort, and speech. Once all parameters are met, the case is sent for fabrication.

CAID All On 4 Plus Dental Implants Melbourne 113

The upper replacement teeth are fabricated using highly aesthetic high-impact acrylic.

CAID All On 4 Plus Dental Implants Melbourne 116

The upper replacement teeth are permanently attached to the implants with tiny screws through the back and the patient can throw away her dentures.

Lower All-On-4 with Keyhole Surgery and Upper All-On-4-Plus Dental Implants

CAID All On 4 Plus Dental Implants Melbourne 144

CAID All On 4 Plus Dental Implants Melbourne 127

This 49-year-old musician has had dental problems all his life and had undergone a cycle of treatments and restorations that have failed. The turning point for him was when he lost his front teeth, and with it he lost his ability to play the saxophone. Apart from being unable to eat many types of food, as an entertainer, he hated his smile and was now facing being unable to perform certain aspects of his work and sharing his musical talents.
We treated him with upper and lower All-On-4 dental implants in early 2008.

CAID All On 4 Plus Dental Implants Melbourne 128

After loosing his front teeth, the patient was given a partial denture, but this was loose and unstable.

CAID All On 4 Plus Dental Implants Melbourne 150

With the denture out, the extent of oral dysfunction is clearer.

CAID All On 4 Plus Dental Implants Melbourne 151

After the teeth were removed, we placed four implants in the jawbone to supported a fixed bridge that fitted on top.

CAID All On 4 Plus Dental Implants Melbourne 152

The permanent All-On-4 bridge is constructed and fitted to the implants within 24 hours after the surgery.

Musician Plays Saxophone Again with All-On-4 Dental Implants

CAID All On 4 Plus Dental Implants Melbourne 164

CAID All On 4 Plus Dental Implants Melbourne 161

At 61 years of age this gentleman never new what it feels like to have a good bite and nice teeth. He had a severe malocclusion due to a genetic discrepancy in the size and alignment of the jaws, crowding of the teeth, and a deep bite. He did not like to smile and was unable to eat many types of food.
Cases like this could have been treated with orthodontic treatment (braces) and orthognathic jaw-correcting surgery at a younger age. By the time he came to see us this treatment was no longer feasible due to the number of teeth that he had lost in large part due to the underlying factor of his malocclusion.
We treated him using All-On-4-Plus Dental Implants in the upper and All On Four in the lower. This gave us a ‘new canvas’ with improved artistic and technical freedom to design the new teeth to a more ideal bite and aesthetic balance.
One of the concerns that we had with this treatment was the rapid change in his bite and alignment of the teeth and how this could affect this gentleman who was used to a certain shape of his mouth and his bite all his life. We informed him that it may take a long time to get used to his new teeth. But when interviewed one year later and asked whether it took him long to get used to the new bite he stated ‘there was nothing really to get used to because the improvement was immediate’.
It is important to emphasise that every situation is different, and both results and experiences may vary from patient to patient. What we do at our clinic is aim to achieve, albeit over a short timeframe, the most optimal individualised result and a long term solution.

CAID All On 4 Plus Dental Implants Melbourne 162

Before the operation, we undertake a complete work-up to determine the required corrections and to plan for the most optimal positioning of the implants. Half of the stone models of each arch were cut back and teeth were set in red wax retaining a reference to the old set allowing the surgeon to visualise the extremity of the planned change in position of the teeth.

CAID All On 4 Plus Dental Implants Melbourne 159

This patient had a complete overbite.  When biting together the lower teeth bite into the gums behind the upper teeth causing discomfort and inability to chew properly.

CAID All On 4 Plus Dental Implants Melbourne 160

Due to the overbite and the lower front teeth not actually meeting opposing teeth in occlusion, those teeth have supra-erupted causing a severe wave in the bite. The upper back teeth have also done the same because of the missing back teeth in the lower against which to bite.

CAID All On 4 Plus Dental Implants Melbourne 163

With All-On-4-Plus dental implants treatment we were able to improve the appearance, but more importantly to correct the bite and arch form.

Correction of a Severe Overbite with All-On-4-Plus Dental Implants

CAID All On 4 Plus Dental Implants Melbourne 140

CAID All On 4 Plus Dental Implants Melbourne 139

Dental problems can often be attributable to genetics, like susceptibility to gum disease, tooth decay, and poor jaw alignment. They can also start from trauma like losing a single tooth, and a cycle of dental treatment that may follow if not planned adequately from the onset.
The person pictured here is a successful businessman and looked after his teeth all his life. Whilst he had some genetic predisposition to tooth loss his dental issues started when he lost a front tooth from a knock.
What followed was years of dental treatment including root canal treatments, gum treatments, fillings and crowns. Whilst each dental issue he had was attended to individually, the underlying problem was a dysfunctional bite that was never corrected, and which led indirectly to further deterioration of his teeth.
He attended the dentist regularly but was never happy with the appearance of his teeth. He resorted to accepting that perhaps he was stuck with what he had been unaware of the possibilities with more definitive treatment planning and dental implants.
The last time he saw his dentist he was told that he needed more treatment, but he was over it and told his dentist that he wanted to have all his teeth out and get dentures like some members of his family. But his dentist was also a close friend and was aware of the limitations of dentures. He became aware of the All-On-4 procedure and referred this gentleman to our clinic.
We treated him in early 2010 with Upper All-On-4 Plus and Lower All-On-4, and within days he was able to smile and function, and bite into an apple, – something inconceivable to him prior.
We continue to see him at our clinic for regular maintenance and at his 4 year review, there was nothing else necessary apart from simple professional cleans. His cycle of failed dental treatments came to a halt. He says that he is not aware of his implants, and the only time he is reminded is when he looks in the mirror and sees the improvement.
Circumstances are different from patient to patient, and in many cases, it is possible to achieve a definitive solution in more conservative ways, but the main advantage of All-On-4 dental implants is the ‘canvas’ that allows us the flexibility to change the bite and design the best possible aesthetics.
Every one of our treatments is individual and depends on many factors. As such results and experiences may vary from patient to patient, but to date, we are proud of having had many hundreds of similar success stories.

Cycle of Failed Dental Treatment Stopped with Upper & Lower All-On-4

CAID All On 4 Plus Dental Implants Melbourne 125

CAID All On 4 Plus Dental Implants Melbourne 118

This 58 Year Old Farmer had lost numerous teeth over the years and had severe wear. The wear got worse the more teeth he lost because the pressure became more concentrated on whatever teeth he had left.
When he came to see us in 2008 his teeth had worn down almost to the pulps of the teeth. We removed his teeth ad rehabilitated him with upper and lower All-On-4 dental implants.
Wearing of teeth is also a sign that a patient may be grinding during sleep or excessive natural muscle tone in normal function. In such cases, it is important for the patient to wear an occlusal splint at night to protect the teeth from continued wear or breakages, even with implant treatment. In some cases, it may be necessary to upgrade to materials such as Zirconia, which is much stronger and more durable.

CAID All On 4 Plus Dental Implants Melbourne 119

The patient presented with numerous missing teeth and dysfunction due to wear. He could not tolerate partial dentures. The remaining teeth were decayed and had gum disease.

CAID All On 4 Plus Dental Implants Melbourne 120

This x-ray taken after surgery shows angulated implants in the back and straight implants in the front, placed using a conventional all-on-4 dental implants technique. Note that this technique allows bypassing of nerve bundle in the lower jaw, and bypassing of deficient bone and sinuses in the upper jaw.

Upper & Lower All-On-4 for Worn Teeth and Collapsed Bite

CAID All On 4 Plus Dental Implants Melbourne 121

This 41-year-old lady had dental treatment done overseas as seen in the before shot. She was not satisfied with the appearance but didn’t really know what to expect. Soon after her return to Australia, she developed pain from numerous of her upper teeth and when seen at our clinic, we discovered the presence of decay affecting many of the teeth under the bridges that were fitted abroad to point that it was not possible to save most of the teeth.
We considered saving 2 teeth, the upper left lateral incisor and canine because they were reasonably healthy, but doing so would have meant that we had to fit an implant-supported bridge segment on either side. This treatment relies on the natural gums for aesthetics, but since the gums here were not only unevenly receded and asymmetrical, but also visible on smiling, the overall aesthetics would have been highly compromised.
Instead, the patient decided to sacrifice two teeth that were otherwise healthy and proceed with All-On-4 dental implants treatment in the top. A feature of this treatment is Aesthetic Gum Replacement, which essentially means that the gum component is replaced as part of the bridge. As such, we had better control and flexibility to design a more balanced look in terms of the appearance of both the teeth as well as the gums, and we were also able to improve the bite at the same time.

Failing bridges and recession of the gums as a result of gum disease and tooth decay under the upper bridges. Note the collapsed bite seen as a dipping on the right of the picture.

After all, teeth were removed (except one in the very back), the gum line was leveled to allow for aesthetic gum replacement for improved appearance of the gum line, to be incorporated into the design of this All-On-4 Dental Implants prosthesis. Note the straighter alignment and bite.

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When the upper bridge is removed, the four supporting implants are visible, and the gums under the bridge appear completely healthy despite this patient's history of gum problems with her natural teeth in the past.

CAID All On 4 Plus Dental Implants Melbourne 123

This picture shows the bridge in place over the implants.  The holes allow access to the screws to enable removal of the prosthesis when required. These holes get closed over with a coloured material.

CAID All On 4 Plus Dental Implants Melbourne 122

An x-ray that takes 15 months after the surgery illustrates the two angled fixtures in the back and two straight implants in the front, with healthy bone levels.

Upper All-On-4 to Replace Failing Bridges and Asymmetric Gums

CAID All On 4 Plus Dental Implants Melbourne 1491

CAID All On 4 Plus Dental Implants Melbourne 136

This 65 Year Old retiree had a full upper denture for many years. In the lower he still had some of his own teeth but they were so badly deteriorated with advanced gum disease that they became mobile and had to be splinted together.
The upper denture was very worn and have become loose. This is a common phenomenon with dentures where bone atrophy occurs over time, which causes the denture to loose its support. The way dentures are retained in the upper jaw is through a cupping of the entire palate and bare gums by the plastic plate and the suction effect that this creates.
In the lower jaw because of its horse-shoe shape there is no effective suction effect like in the upper. As such, looseness, movement and discomfort are a far bigger problem.
In treatment planning for this retiree cost was a major consideration. He initially said that he was not able to afford to do both upper and lower implants, and wanted to have a lower denture and implants in the upper only. It is a common request for patients to prefer to do the upper first, but it is not the best way because of the particular problems with lower dentures described above.
Instead, we recommended as a cost-saving exercise to have the LOWER dental implants first, and an upper denture. As an upper denture is typically more stable than a lower, this course of treatment is typically the most efficacious and provides better overall function.
As it turned out, this gentleman’s children helped him to do both the upper and lower All-On-4 dental implants at the same time, and by doing them together we had the flexibility to restore both the appearance and bite to ideal.

CAID All On 4 Plus Dental Implants Melbourne 137

This picture illustrates the worn upper denture and the lower teeth that were splinted together because they were loose from periodontitis.

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The lower teeth were removed along with the infections and gum disease, and four implants were placed in each jaw at the same time. Note that the gums have been flattened and the implants adequately spread to provide the required support for the subsequent bridges.

CAID All On 4 Plus Dental Implants Melbourne 148

The final upper and lower All-On-4 prostheses are permanently fitted to the fixtures with screws.  Note the flat interface between the natural gums and the prostheses for ease of cleaning.

Fixed alternative to loose worn denture

CAID All On 4 Plus Dental Implants Melbourne 156

CAID All On 4 Plus Dental Implants Melbourne 155

This 55 year old lady had numerous missing teeth that were replaced with a denture. You can see in the before shot the metal clasps that are typical, which help stabilise the denture. However, whilst replacing the missing teeth, the patient was unable to bite or chew many foods, and hated the look of her teeth.
Apart from the issues that this patient was aware of, there were other factors that had to be taken into account when considering the various alternatives and planning her treatment. She had a scissor bite on the left, a very narrow arch form giving her a narrow smile, back teeth that are supra-erupted because there were no teeth on the lower to bite against, and very thin gums.
One of the options considered was keeping the existing teeth and replacing only those missing with individual dental implants. However this treatment had many limitations. Firstly, when placing implants in thin-type gums, there is a predisposition to recession, and the this causes more unevenness in the gums as well as dark margins around the teeth. Secondly, with individual implants we are unable to address the underlying problems with the bite, and arch form.
The patient came to our clinic for implants, but what she really wanted wasn’t ‘implants’. She wanted a nice smile and functional teeth. To give her that we had to remove the teeth, and this gave us the freedom to design her bite and aesthetics from the ground up. We treated her with Upper and Lower All-On-4 in 2011 and fitted the permanent teeth seen in the after shot within 24 hours from her surgery.

CAID All On 4 Plus Dental Implants Melbourne 145

The three upper front teeth are denture teeth, held in by the metallic clasps on the sides. The rest of the teeth are compromised because of large restorations. Note the uneven occlusal plane, scissor-bite, and extremely thin gums.

CAID All On 4 Plus Dental Implants Melbourne 154

After the teeth were removed, four implants were placed in each jaw. This picture shows the lower implant bridge in place and the four fixtures that support the upper bridge.  Note the flatter interface, which simplifies cleaning under the bridge, and the stable thicker gum-type, the result of our augmentation procedures that we do as part of our All-On-4 process.

CAID All On 4 Plus Dental Implants Melbourne 146

The x-ray illustrates the upper and lower All On 4 treatments.  To improve the durability of the teeth, a metal bar is incorporated into the bridge, visible as a horizontal white line. Two teeth were kept in the upper temporarily to help the patient figure out her new bite.

Before and Afters

Smile makeover with Porcelain shell Crowns for crooked and gappy teeth

Smile Makeover with Porcelain Shell Crowns

Oral Rehabilitation with Porcelain Crowns to correct tooth wear and collapsed bite

Gum Lift and Porcelain Veneers to correct gingival imbalance

Gummy Smile treated with Gum Lift and Porcelain Veneers

Makeover with Dental Crowns

Porcelain Crowns to Correct Crowding

Old crowns replaced with Porcelain Crowns

New ceramic crowns to replace poorly-made crowns

Porcelain Veneers to treat flat, worn and discoloured teeth

All-On-4 Zirconia Porcelain Teeth

Zygoma-Plus Treatment After Failed Dental Work Infections

Lower All-On-4 with Keyhole Surgery and Upper All-On-4-Plus Dental Implants

Musician Plays Saxophone Again with All-On-4 Dental Implants

Correction of a Severe Overbite with All-On-4-Plus Dental Implants

Cycle of Failed Dental Treatment Stopped with Upper & Lower All-On-4

Upper & Lower All-On-4 for Worn Teeth and Collapsed Bite

Fixed alternative to loose worn denture

Smile and Bite Makeover with Upper and Lower All-On-4

Upper Implant-Supported Bridges

4-Unit Bridge supported by two Dental Implants

Two Missing Teeth Replaced with a Single-Implant-Supported Bridge

Fractured Teeth Replaced with an Implant Bridge

Fractured Incisor Tooth Replaced with an Immediate Dental Implant

Dark Tooth Replaced with a Dental Implant

Eroded Teeth Replaced with All-Ceramic Dental Implant Bridges

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