Smile Gallery

This represents an example of how dental implants can be utilized to replace certain missing teeth within the dental arches.

In this case, the patient was missing posterior or back molars and some bicuspids. We replaced the missing teeth by surgically placing dental implants to provide crown and bridge support, and then subsequent crowns and bridges were bonded to the implants. The remaining teeth with healthy, predictable root structures but with broken-down enamel and dentin were redesigned and crowned.

In this example, all teeth and implants were crowned. This afforded a “new bite” and a restoration of the vertical dimension ( the height of the upper and lower teeth, when in a closed position and in contact with each other, determines the length of the lower third of the face). This is extremely important in restoring facial esthetics and a more youthful look to a patient.

In this case, all teeth were crowned, and the crowns were designed, fabricated, and restored by the doctors with our “in-house” CAD-CAM ceramic crown and bridge technologies. This gives us the ability to completely customize each and every treatment to fit the individual patient.

An added benefit for the patient is the fact that all crown designs of each and every patient are stored in our digital archives, and any of the crowns can quickly be fabricated to provide an immediate replacement crown should one or more be damaged due to trauma.

Summary of Benefits:

1. Preservation of existing dentition ( teeth).
2. Restoration of lower facial dimension ( tip of nose to base of chin).
3. Uniform shade matching, but variation created from tooth to tooth to disguise the fact that teeth are crowned.
4. No visible crown margins can be seen at the gum line due to all-ceramic construction
5. Replacement of missing molars, restoring posterior biting function, and providing protection to the new crowns in the smile line.
6. creation of good gingival health
7. Elimination of the “gap” or space between the anterior teeth.

This patient presented with broken down, darkened, decayed, and crowned teeth and desired a completely functional and esthetic rehabilitation of her natural dentition. She had some fluoroscopic staining from excessive fluoride, which had grayed her teeth, as well as unmatched crowns and large fillings in her smile zone.

This treatment required no dental implants as no teeth were missing and all could be restored with crowns. All teeth were crowned with all-ceramic crowns.

This view demonstrates the contrast of the Pre-Treatment and after smile from the left anterior view.

This can be accomplished in a single appointment if desired by the patient.

This patient had worn the removable implant prosthesis, on the left upper arch, for over thirty years. She came to our office in 2012 requiring a new prosthesis.

After evaluation, CT scan, diagnostic wax-up, we determined we could convert this patient to a fixed (non-removable) prosthesis for the upper arch.

Although she had been completely satisfied with the appearance of the original prosthesis on the left, we convinced her to let us try some different tooth selections, positioning, and shading for the teeth to be fabricated into the new prosthesis.

The view to the right is her natural smile which is greatly different from the one she wore for over thirty years. She and her family accepted and like the “new” look because it is a natural look and fits her facial form and age.

A particular advantage is that she now has a prosthesis which she cannot remove and therefore it is always stable, stationary, and does not allow for “sore spots”, a common problem with patients who wear removable prostheses (dentures).

These solutions do not require constant trips to the office for maintenance and/or replacement of the attachment components which are embedded in the prosthesis and which hold the prosthesis in position over the implants. These attachments can and do wear out periodically and must be correctly replaced in a timely manner for the prosthesis to remain comfortable and functional.

In this case, six new implants were placed in the upper jaw and the patient was able to continue wearing the old prosthesis during the required healing stage of the implants. Once healed, the new prosthesis was fabricated and replaced with the old prosthesis accompanied with removal of the original implant system which was of a totally different design from the one we used.

In its day, the original system was the best we had to offer and the fact she wore it successfully for many years is a testament to the system and her original providers. Today, however, there are many options that allow for many different innovative solutions.

A single central incisor that fractured off close to the gingiva ( gum), requires replacement with a new crown and an underlying support system, termed a post and core buildup, which provides for a foundation to which a new all-ceramic crown can be bonded.

We have the capability to complete this type of treatment in one appointment in as little as an hour and a half.

We accomplished this result in one appointment of about 2 hours since the foundation of the root had to be rebuilt prior to fabricating the ceramic crown in the office.

An advantage to our “in-house” capabilities is that the crown is then stored in our digital archives and we can instantly generate a replacement crown from that data if the patient ever damages the crown. This is an efficient and less expensive replacement should there be breakage from a trauma event.

Typical socket bone graft:

This case demonstrates the benefit of placing a bone graft into the root socket space when a tooth, in this case, a molar, has been extracted. The photo to the left shows the remaining root socket of the extracted molar and the roots of the molar positioned to the posterior.

Although this x-ray is a two-dimensional digital x-ray, we did take a CBCT scan of the patient on our in-office CT scanner. The 3D images can be rotated and viewed from any angle we wish and showed us exactly where the main branch of the Mandibular nerve lies so that it can be avoided during any surgery. It also better identified the defect we were going to treat.

If the socket were allowed to simply heal without bone grafting, the socket walls would cave in and shrink by 40 to 50% in vertical height and 50% of the width of the ridge. This complicates the future placement of dental implants since there is much less bone to work with.

The film to the right shows the completed and healed bone graft, implant in position, and the final abutment and crown in place. This graft and implant have been in place for over six years as of 2014.

If this option had not been done, the patient would either live with the loss of the molar and likely a severe compromise of the most rear molar. She would likely be missing two molars due to the defect and required multiple implants to restore the area with permanent teeth over implants.

Photo Legend:

Left pre-op photo: Shows the remaining bony socket after removal of the damaged molar.

Right post-op photo: Shows the bone graft in place and the implant embedded in the graft material. The crown and abutment are in place and the site is fully reconstructed.

NOTE: after a time frame of from six months to 1 year this type of bony graft material is resorbed away and replaced with the patient’s own native bone.

This demonstrates a young person, 30+, who has many missing posterior teeth and large gaps between her natural teeth as well as having significant decay (cavities) and several broken down teeth beyond restoration. Her teeth and smile are her major nutritional and esthetic compromise, as she is a very attractive young lady. When she first presented her diet was seriously limited to only soft and sweet foods so that her nutrition was seriously compromised.

The goal was to save and restore the remaining natural teeth which had a good long-term successful prognosis with proper restorations. The missing teeth were replaced with dental implants and dental crowns and/or with dental bridges attached to the dental implants. No part of the final case presentation is removable by the patient. We call this a “fixed” case or treatment.

The photo to the right shows the completed smile. The gaps between her natural teeth on the left photo were all closed with the crowns without the need for orthodontics or misshapen dental crowns.

All crowns were custom designed and fabricated in our office using our digital technologies.

This treatment restored her comfort, function, and esthetics and greatly complimented her appearance.