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Other candidates for full mouth treatment have all or most of their teeth. Many of these patients have great bone and bad teeth making them perfect candidates for fixed bridges.
Lips retracted view shows the extent of tooth breakdown. Due to moderately bad cavities the collective decision was made to transition him from teeth to teeth plus strategic implants to only implants. He was emphatic about not wearing a denture. So, to honor his wishes to not use a denture and have the result be fixed bridges on implants a very custom and extensive treatment plan was formulated. In “transitional” implant treatment there are additional appointments and a longer treatment time, but the end result is far superior to All-on-4.
The panoramic x-ray before treatment. Note his excellent bone. Bone is precious and should not be removed (like the All-on-4 protocol).
Stage one: Fixed, plastic temporaries in both arches. Aesthetic improvements are already quite obvious. These will serve the patient for several weeks and prepare him for the first surgery.
At the first surgery, strategic teeth are removed and some implants placed. The temporary bridges are modified to accommodate the new arrangement.
After two months of implant healing, the remaining teeth are removed, additional implants placed and the temporary bridges modified or new ones are fabricated. See next picture.
New upper and lower temporaries are fabricated and are retained by only the implants as there are no natural teeth remaining.
Two months later, after implant and gum tissues are ready, impressions are made and a wax mock-up tried in the mouth. This is where the dentist, the patient and any family members whose opinions count Wax, mock-up on model. This is the appointment where the dentist, the patient and any family members whose opinions count are encouraged to critique the appearance of the teeth. We evaluate the color, length, width, smile, non-smiling appearance, overall arch form and appearance while speaking. No stone is left unturned as this will be the last time the teeth can be changed. If are necessary, another try-in of the mock-up is completed.
Wax, mock-up off model.
Wax, mock-up, smile. This is the best way for the patient and family to evaluate the appearance.
Wax, mock-up, lips retracted.
Final zirconium fixed bride, lips retracted.
Final lower zirconium fixed bridge, lips retracted.
Final fixed bridges, left lateral, mirror view.
Final fixed bridges, right lateral, mirror view.
Final fixed upper bridge, mirror-occlusal view.
Final result, smile.
Final result, full face smiling.
Final panoramic x-ray. Note: parallel implants, no angled abutments, easily cleaned contours.