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Cosmetic Solutions for Missing Teeth (Edentulated Jaws)

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A smile makeover using mini implants and dentures helps mee the cosmetic and economic demands of today's growing denture wearing public.

Old worn out denture
More than 10 years old, dentures were not very functional, with badly worn - discolored acrylic teeth, loss of canine guidance causing more wear posterior teeth

Old worn out denture
The teeth chosen for the replacement denture were set in wax for try-in

Old worn out denture
The final upper and lower dentures were delivered - patient was pleased with the esthetics

The concept of cosmetic dentistry entails a set of techniques and procedures used to enhance an individual's teeth, smile, and ultimately, confidence. A smile makeover that significantly improves appearance can lead to a more positive lifestyle, both socially and professionally.

General practitioners can use numerous techniques, individually or collectively, to dramatically improve the teeth, gums, and smile. These procedures range from simple tooth whitening to complex multiple- tooth restorations and full-mouth reconstruction.

Denture Cosmetics

However, one significant sector of our society that may have been overlooked in this growing trend of cosmetics are patients who already have lost their teeth. Most of these individuals have become edentulous due to periodontal disease or tooth decay, and are functioning with dentures or other forms of removable dentistry.

Many are displeased with and embarrassed by their appearance.

With today's advances in denture materials and fabrications, denture patients can have their smiles restored to proper esthetics, form, and function. However, conventional mandibular dentures for patients who have severely atrophic mandibles frequently present problems with retention, phonetics, function, and pain, due to instability.

Over the years, traditional implants have been used successfully to restore toothless lower jaws with implant supported fixed bridges, hybrid prosthetic dentures and removable overdenture prostheses.

Standard Implants versus Mini Implants

The mandibular ridge was moderately narrowed

Implants and dentures can't be used in all cases.

Atrophy of edentulous jaws may limit implant placement in the mandible. Anatomic limitations and resorbed alveolar ridges may compromise implant numbers, lengths, and inclinations.

The use of standard diameter implants to support an overdenture often requires ridge augmentation (bone grafting) in these patients to have sufficient bone to allow implant placement.

Also, older patients who have serious medical problems or who use anticoagulant therapy may exhibit an increased risk of complications. On the other hand, with technological advancements like mini dental implants, even those individuals who may not have had enough bone structure for conventional implants can benefit from implant-retained prosthetics.

Small-diameter implants placed with flapless surgery to support preexisting conventional dentures offer a method of restoration in patients with atrophic mandibles.

Advantages of this procedure include implant placement without any bone augmentation surgery, minimally invasive surgery resulting in virtually no bleeding, and decreased pain and cost of treatment.

Implants are fully seated, with the threads and base subgingival and only the abutment head exposed

The following case history example outlines the steps used in meeting the esthetic demands of the edentulous patient with cosmetic dentures and the functional component in retaining those dentures with mini dental implants.

Case History Example

The series of photos appearing here represent the before, midtreatment and final outcome results of a treatment plan for a 50+ year old male who was dissatisfied with his existing set of complete upper and lower dentures. The dentures were over 10 years old.

The location of each implant was transferred to the denture

It was apparent that the patient's dentures were not very functional. The acrylic teeth were severely worn and discolored. The patient also exhibited an end-to-end bite. Clearly, there was protrusive wear evident on the maxillary canines and lateral incisors. The loss of canine guidance resulted in increased wear on the posterior teeth, further reducing the vertical dimension. The edges of the maxillary denture teeth were not very visible in a relaxed position.

All these factors made the patient appear older than his stated age. In addition, some discomfort presented in the TMJ due to bruxism and an inadequate vertical dimension, and there was very little retention remaining in both the upper and lower dentures. Soft tissue analysis, however, was within normal limits. Having been a denture wearer for more than 25 years, there was very little ridge height remaining in the mandible. In addition, the patient's medical history revealed diabetes and some hypertension.

Placed over each implant, a small plastic shim allows only the O-ball to be exposed

The Smile Guide reference (Discus Dental) was used to complete the smile analysis necessary in predesigning the case. The lip line edge versus the incisal edge of the denture teeth suggested that lengthening the incisal edges would enhance the patient's smile. The results of the smile analysis and pre-operative photos were reviewed with the patient to identify a treatment plan to improve his smile and function of his dentures.

The patient expressed dissatisfaction with the appearance of his dentures and desired a better fitting set with whiter, longer teeth that would give him a more youthful appearance. Since very little ridge height remained in the lower arch, the patient requested having his lower denture retained by using mini dental implants, due to their ease of placement and low cost.

Our goal in the rehabilitation was to provide a set of dentures that would meet the patient's esthetic requirements as well as remain retentive enough to eat the foods he desired, within reason. BlueLine Teeth (Ivoclar Vivadent) were selected for their natural-looking esthetics and resistance to wear.

A female O-ring keeper cap was fitted over each implant

Blue Line teeth are fabricated from a Double Cross Linked (DCL) resin material. The density of this DCL material provides high wear and plaque resistance, shade, and stability, as well as resistance to breaking or cracking, and optimal bond to denture base materials. Omtec mini dental implants (MDI) were selected to provide retention of the lower denture.

Using the patient's existing dentures as custom impression trays, impressions were taken. Secondly, a bite registration was taken, using a quick-setting material that set up in 60 seconds. This bite registration would assist the lab in positioning the relationship of the maxillary and mandibular arches and vertical dimension. Once the record bases were fabricated, the chosen teeth were set in wax for tryin (see 2nd photo).

Dramatic Denture Cosmetics
The dentures were tried in and evaluated for proper esthetics, phonetics and function. The patient approved the overall look, size, shape, and color for final processing. After the final maxillary and mandibular complete dentures were delivered, the patient immediately expressed how pleased he was with the cosmetic result.

The fit and occlusion were checked immediately, and any discrepancies in occlusion were relieved. Shortly thereafter, the patient was dismissed with proper denture maintenance and care instructions.

Patient confidence restored

Current advancements in implant design technologies and denture fabrication processes and components enable many prosthododntic dentists to address the common problem of having dentures that fit great and look great. The advent of the mini dental implant especially has given general dentists a rapid, easy, and less costly way to solve the common problems of most denture wearers.

It is estimated that more than 36 million patients in the United States have lost all of their teeth; however, only one-half of 1% have received implant therapy!

Ara Nazarian, D.D.S.
Michigan Reconstructive Implant Dentistry
1857 East Big Beaver Road
Troy, Michigan MI 48083
(248) 457-0500

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