Pre-op, frontal full-face smile.

Pre-op, frontal full-face smile, lips retracted.

Pre-operative smile picture.

Lips retracted, left lateral view.

Lips retracted, right lateral view.

Pre-op panoramic x-ray.

Day of surgery panoramic x-ray. Test implants were placed and adequate insertion torque was obtained (bone density and implant stability measured ≥ 25 Newton-centimeters) which qualifies multiple implants for immediate temporaries. All other teeth were extracted and a total of eight implants placed in the upper jaw (maxilla).

Immediate, fixed temporary bridge.

Day of surgery placement of the immediate, fixed temporary bridge on all implants. Not the convex contours to which the tissues can heal, ideally.

Two months later, frontal smile picture. What an improvement!

Two-months, right lateral smile view.

Two-months, left lateral smile view.

Two-months, full face, frontal view.

Prototype-wax-up-try-in. Used to determine length, width, overall smile, and bite (lips retracted).

Prototype-wax-up-try-in. Used to determine length, width, overall smile, and bite (smile).

Prototype-wax-up-try-in. Used to determine length, width, overall smile, and bite (full face, smile).

Frontal view, master cast with titanium cylinders before cementation of the zirconia bridge.

Occlusal view, master cast with titanium cylinders before cementation of the zirconia bridge.

Zirconia bridge before cementation to the titanium cylinders (frontal view).

Zirconia bridge before cementation to the titanium cylinders (tissue view).

Zirconia bridge on master cast (frontal view).

Zirconia bridge on master cast (occlusal view).

Zirconia bridge cemented to the titanium cylinders (tissue view). This is how screw retention (the superior implant connection) is achieved.

Zirconia bridge cemented to the titanium cylinders (frontal view).

Mirror view of the tissues before delivery of the zirconia, implant bridge. Note the excellent volume of good, pink tissue (keratinized tissue). This good tissue is what allow the bone to remain healthy and full for many years if not forever.

Final, zirconia bridge (frontal view, lips retracted).

Final, zirconia bridge (frontal view, lips retracted, patient biting).

Right lateral (mirror) view of bridge. Note the “normal” contours that mimic natural teeth.

Right lateral (mirror) view of bridge. Note the “normal” contours that mimic natural teeth. Slight metal exposure of implant #4. Nothing can be “perfect” and we try to keep this from happening. However, some patients have existing bone loss that prevents perfection.

Mirror view of final implant bridge. The screw holes have been sealed with composite resin. This plastic filling material can be easily removed to remove and clean or service the bridge. We call this “retrievability”.

Post-treatment panoramic x-ray. Note: no angled implants or abutments. Implants are placed where the roots of teeth were. Prosthesis is easily cleaned.