Serving all of Central and Western Montana ~ Located in Missoula

Case Study 6: Implant Prostheses

The patient is a female in her early 60's who has been wearing a complete denture for nearly 40 years on her upper jaw.  She has a partial completement of teeth in her lower jaw that was supporting a removable partial denture.  She has had several replacement dentures and partial dentures fabricated in the past.  She presents wishing to recieve more servicable and esthetic prostheses.

This case study demonstrates full mouth reconstruction with dental implants.  The upper prosthesis was supported with a metal bar attached to implants, and was removable by the patient for cleansability purposes, while the lower was fixed in place for the patient, but able to be removed by the dentist for maintanence purposes.

Testimonial from the patient:

"Dr. Joe Meng is a conscientious hard working person.  I was fortunate enough to be treated by him while he was studying at Baylor Dental Hospital. He worked tirelessly to perfect my treatment, performing miracles for a deteriorating situation.  He showed caring professionalism and dedication during his long tuition and I know this will continue when he is in practice.  I will always be indebted to him and would thoroughly recommend his work to anyone!"

  • The patient is a female in her early 60's who has been wearing a complete denture for nearly 40 years on her upper jaw.  She has a partial completement of teeth in her lower jaw that was supporting a removable partial denture.  She has had several replacement dentures and partial dentures fabricated in the past.  She presents wishing to recieve more servicable and esthetic prostheses.

    This case study demonstrates full mouth reconstruction with dental implants.  The upper prosthesis was supported with a metal bar attached to implants, and was removable by the patient for cleansability purposes, while the lower was fixed in place for the patient, but able to be removed by the dentist for maintanence purposes.

  • The patient is a female in her early 60's who has been wearing a complete denture for nearly 40 years on her upper jaw.  She has a partial completement of teeth in her lower jaw that was supporting a removable partial denture.  She has had several replacement dentures and partial dentures fabricated in the past.  She presents wishing to recieve more servicable and esthetic prostheses.

    This case study demonstrates full mouth reconstruction with dental implants.  The upper prosthesis was supported with a metal bar attached to implants, and was removable by the patient for cleansability purposes, while the lower was fixed in place for the patient, but able to be removed by the dentist for maintanence pruposes.

    Joe Meng, DDS, MS

  • Examination of esthetic parameters reveals upper teeth positioned outside of normal limits, which gives a very  unnatural and"fake" appearance to the prosthesis.

    Joe Meng, DDS, MS

  • Examination of esthetic parameters reveals upper teeth positioned outside of normal limits, which gives a very  unnatural and"fake" appearance to the prosthesis.

    Joe Meng, DDS, MS

  • Examination of the upper and lower jaws without both prostheses in place, reveals compromised teeth on the lower jaw from a standpoint of structure, periodontal disease, dental decay, and poor positioning, that do not lend them to being strategic teeth to supporting a future prosthesis.  The upper jaw is very atrophic from long term tooth loss and denture use, and is also not very servicable for supporting a prosthesis without the aid of dental implants.

    Joe Meng, DDS, MS

  • A view of the compromised lower jaw.

    Joe Meng, DDS, MS

  • A view of the compromised upper jaw.  The physiology of the human body is such that when tooth loss occurs, bone and tissue loss will occur over the course of many years.  Use of a denture additionally will accelerate this process, and render a denture bearing jaw unserviceable for supporting and retaining a denture after many years of use.

    Use of dental implants are benificial to this cause, because the body will continue to maintain bone around implants, similar to that of a tooth, and will prevent long term bone loss.

    Joe Meng, DDS, MS

  • Pre-opperative panoramic radiograph, demonstrating severe bone loss of the upper jaw, and periodontal disease of the lower jaw.

    Joe Meng, DDS, MS

  • The first stage of treatment was extraction of the remaining lower teeth, and bone grafting of the upper jaw to provide the necessary bone to anchor future dental implants.  Because the upper jaw was extremely deficient of bone, bone was transplanted from the patient's hip to the upper jaw.  

    After 8 weeks of initial healing, the patient was able to wear immediate "healing" dentures on the upper and lower jaws (above photo).  Multiple tissue liners were placed on the tissue bearing surfaces of both during the healing process, to help maintain function and comfort.

    Bone used for grafting may be used from a variety of sources: the patient own bone, sterilized cadaver bone, sterilized animal bone, or synthetic bone.  Advances in bone grafting proceedures are starting to eliminate the more invasive bone grafting proceedures.

    Joe Meng, DDS, MS

  • Immediate "healing" dentures in place.

    Joe Meng, DDS, MS

  • Dental implants were placed after 4 months of healing following bone grafting on the upper and lower jaws.  2 months following implant placement, the lower denture was converted to an interim fixed prosthesis anchored to the lower implants.  The implants on the upper jaw required more healing time because they were placed in grafted bone.  Conversion of the lower implants was done to provide the patient with much better function until the final prosthesis was able to be made.  The white "domes" seen on the upper jaw are healing caps attached to the dental implants.

    Joe Meng, DDS, MS

  • 4 months following placement of the dental implants on the upper jaw, a titanium bar was fabricated using state-of-the-art milling technology to provide an extremely accurate fit to the 5 implants.  This bar will be used to support and retain a removable prosthesis.  A bar is not always required for anchoring a removable prosthesis, but was for this patient because the implants were placed in grafted bone.  Grafted bone does not anchor implants quite as well as a body's native bone would, so more implants and splinting with a bar is typically done to provide for a more predictable long term prognosis, when the implants are placed in grafted bone.  

    A titanium alloy is the metal of choice due to biocompatability and strength.

    Joe Meng, DDS, MS

  • Final upper prosthesis in place.  When a suficcent number of dental implants are utilized on the upper jaw, the palate portion that typically covers the roof of the mouth can be removed.  This allows for a less combersome prosthesis, as well as allows the patient to taste more, because some of the minor taste buds housed in the roof of the mouth can now be exposed to food during eating.  The small gold colored pins seen on the back outer portions of the prosthesis are used to anchor the prosthesis to the bar.  This one of many attachement systems used to serve this purpose.

    A removable prosthesis was used on the upper arch because a "flange" was used to support the upper lip to provide for acceptable esthetics.  Whenever a flange is used, the prosthesis becomes uncleansable if is it not able to be removed daily by the patient.  In most situtations like this, when teeth have been absent for a period of time, a flange is required to provide adaquate support of the upper lip.

    Joe Meng, DDS, MS

  • View of lower fixed-implant supported prosthesis.

    Because a flange was not necessary on the lower arch, a fixed prosthesis was able to be provided with acceptable access for daily hygiene practices.  This prosthesis is able to be removed easily by the dentist if needed for repair/mainanence purposes, although it is not removed by the patient.  The understructure of this prosthesis is also a milled titanium framework, to provide maximum strength and resistance to fracture.

    Joe Meng, DDS, MS

  • View of the upper and lower implant supported prostheses in place.

    Joe Meng, DDS, MS

  • Panoramic radiograph post treatment showing the dental implants and prosthetic hardware in place, verus pretreatment.

    Joe Meng, DDS, MS

  • Smile with final implant prostheses in place.

    Joe Meng, DDS, MS

  • Smile with final implant prostheses in place.

    Joe Meng, DDS, MS

    • Before and after profile views demonstrating the remarkable esthitic improvement, due to appropriate tooth positioning of the upper front teeth.

    Joe Meng, DDS, MS

  • Full face smile with final implant prostheses in place.

    Joe Meng, DDS, MS

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