Pre-op, frontal full-face smile.

Pre-operative, smile.

Pre-op, lips retracted, both jaws.

Upper frontal view, denture out.

Pre-op upper denture out, occlusal mirror view.

Lower pre-op with partial out.

Pre-op, Panoramic x-ray. Note: Excellent bone in the upper front, reasonably good bone everywhere else.

Lower teeth extracted, some bone removal lower, 8 upper implants, 5 lower implants, lower immediate temporary bridge.

Lower temporary in place.

Patient will continue to use his prior upper denture for three months as most of the upper implants were not stable enough for immediate temporary. After 3 months of healing, these implants will be ready for a fixed temporary bridge.

Post-surgical panoramic image.

Three months post, first surgery the patient returns for implant uncovering and these are the impression copings preparing for the fixed temporary bridge.

Upper fixed temporary bridge.

Upper fixed temporary bridge, in mouth. Note: soft tissue health/ fullness.

Panoramic image of the freshly placed upper temporary.

Frontal temporary smile. The patient heals for two additional months and returns to start the process for fabrication of the permanent implant bridges. We begin by assessing and photographing the temporary bridges. There are several issues with the first temporary bridges. Mainly, because he wore his original denture after the first surgery, we were unable to correct the left-to-right cant (slant) until now.

Right Lateral smile.

Left Lateral smile.

Upper Master Cast. This is the “working model”.

Lower Master Cast. This is the “working model”.

Frontal view of articulated Master Casts. We use the temporary bridges in a procedure called “records” to articulate the Master Casts to the articulator. This gives us the static and dynamic recording of the patient’s mouth and bite.

Right lateral view of articulated Master Casts.

Left lateral view of articulated Master Casts.

A duplicate of the temporary bridge is made. Modifications are made to the duplicate. These changes are then sent to the laboratory for further modification.

Over the next few days, the lab modifies and improves the duplicate. These modified duplicates now considered “prototypes” will now be sent back to the office for “Try-in”.

Prototype try-in, smile. The temporary bridges are removed and the prototypes placed. This is where the most scrutiny takes place as we want the patient and family to be thrilled with the appearance and bite. This is the last time changes can be made.

Prototype try-in, full face smile.

Prototype try-in, frontal, lips retracted.

Shade selection.

Permanent implant bridges on articulator, frontal.

Upper implant bridge on cast, occlusal.

Lower implant prosthesis, occlusal.

Upper cast, off model showing “convex” tissue contours.

Lower prosthesis, also convex for cleaning.

Occlusal, mirror view upper. Upper soft tissue development. Amazing tissue response.

Frontal soft tissue development. Note we have reformed some of the missing interdental papilla. This is not easy, patient who had worn a denture for 40 years.

Occlusal view of lower soft tissue.

Frontal view of lower soft tissue.

Frontal view of permanent restorations, day of delivery.

Right lateral view of permanent restorations.

Left lateral view of permanent restorations.

Frontal smile, permanent restorations.

Full face, frontal smile.

Post-treatment panoramic image.

Lips retracted; 24 hours post-delivery. Note the amazing tissue response! This is possible, even in denture wearers if we do not remove bone as is done in the All-on-4 treatment.

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