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.
An x-ray showing failing dentition and 2 implants recently placed to replace only the front segment of missing teeth.
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.
The two fixtures can be seen as yellow/gold screws partly covered by the gum.