Preoperative frontal lips retracted

Preoperative lips retracted frontal in occlusion

Preoperative frontal lips retracted lower

Preoperative, crowns removed, crown preparations

Intraoperative, crowns removed, occlusal view, crown preparations

Intraoperative, provisional restorations, upper

Preoperative lower with provisional restorations upper

Lower crown and veneer preparations

Final impression of the lower preparations. Notice the accuracy of the margins which is the most important part of restorative dentistry. Sloppy impressions which do not accurately capture the margins of the preparation will lead to “recurrent decay”. Dentistry always blames the patient but, most times, it’s the incompetence of the dentist that causes “recurrent decay”.

Provisional restorations lower arch

Master cast of lower preparations

Crowns / veneers on lower master cast, frontal view

Crowns / veneers on lower master cast, lingual view

Crowns / veneers on lower master tasks, right lateral view

Crowns / veneers on lower master cast, left lateral view

Lower crowns / veneers delivered frontal view

Moving back to the upper arch on the day of surgery, upper provisional restorations, frontal view

Upper arch on the day of surgery, upper provisional restorations, occlusal view

Periapical radiograph of two failing central incisors after root canal and post therapy

Extraction of 2 central incisor root

Central and sizer sockets after extraction

Early preparation for implants of the central incisors

Intraoperative periapical radiographs to check angulation and position after initial preparation

Additional preparation for central incisor implants

Intraoperative periapical radiographs to check implant position

Intraoperative periapical radiographs at a slightly different angle to check implant position

Central incisor implants placed, occlusal view

Central incisor implants placed, frontal view

Central incisor periapical radiographs, immediately post placement

Central incisor implants, occlusal view, immediate post placement

Cover screws placed on implants

Bone grafting with cow bone, immediate post placement

Provisional restorations tried back in immediate, post placement

Raw view of the modified provisional restoration, frontal view

Raw view of the modified provisional restoration, birds eye view, front

Refined and polished provisional restoration, birds eye view, front

Refined and polished provisional restoration, birds eye view, back

Modified and polished provisional restoration, birds eye view, frontal

Provisional restoration delivered on the day of surgery

Provisional restoration 2 weeks later. Note: beautiful tissue development and health

Three months post implant placement, bone graft and provisional modification, frontal view. Note: when patients wear beautiful, comfortable provisional restorations there is no rush to complete the treatment. We give tissues ample time to heal.

Three months post implant placement, occlusal view

Final crown preparations and implant impression copings preparing for final impression

Impression copings are luted together with a dimensionally stable resin to improve accuracy and durability during the laboratory process

Final impression of the maxillary teeth

A second final impression is always made in large cases in the event of any inaccuracies in the first impression

Orientation photographs are always taken to ensure proper midline position

Close-up of orientation photograph

Even closer

Lateral views are also taken to assist the laboratory with proper tooth orientation

Opposite side lateral view

Upper master cast, frontal view

Upper master cast, occlusal view

Final restorations, upper, frontal view

Final restorations, upper, occlusal view

Final restorations, upper, right lateral view

Final restorations, upper, left lateral view

Central incisor, screw retained, implant crowns

Central incisor, screw retained, implant crowns, tissue/mirror view

Day of delivery, preparations, frontal view

Reduction copings for additional space for porcelain thickness, pre modification

Reduction copings for additional space for porcelain thickness, post modification

Preparations reduced, frontal view

Preparations reduced, occlusal view

Healing caps removed from implants. Note: abundance of keratinized gingiva

Implant crowns tried-in. Houston, we have a problem. As careful as we are during the impression process sometimes errors are introduced in the laboratory.

All the other crowns are tried and successfully and delivered permanently

New orientation pictures are taken

A new final impression is made of the central incisor implants and the new crowns in position

Temporary restorations are modified from the prior temporary to serve in the interim while new crowns are being fabricated or the existing crowns modified