Want a new smile!

 

Background:

This patient presented after she had lost all her upper teeth due to advanced untreated periodontal disease. After the condition was treated and a good standard of oral health had been re-established, the treating clinician then had a removable prosthesis manufactured. While this approach was successful, something was missing. Most patients struggle with the transition from being dentate to becoming edentulous, and our patient was no different. With the lack of fixation and stability of the denture, the patient also found life with a plastic palate “uncomfortable”. Alongside these functional issues the patient also felt that, while the shade of the teeth were “ok”, everything else about the denture was “just not right”.

 

 

On reviewing the diagnostic images Fig. 1, 2 & 3 we came to these conclusions:

 

1.   Tooth position was incorrect both in long axis and facial position


2.   The teeth were too small for the patient and did not fit her face


3.   The vertical dimension was incorrect


4.   These issues resulted in lack of lip support and overclosure.

 

 

Implant Placement & Aesthetic try in.

The next stage of the patient's rehabilitation was for 6 implants to be placed in the maxilla. Once the clinical team established that the implants had successfully achieved osseointegration, the next phase of treatment could begin.
 
After all the usual and extremely important planning stages and been completed (Fixed bite blocks and Verification Jigs etc) it was  time for the important trial smile evaluation. (Fig. 4, 5 & 6).
 
In these images we can see a much improved appearance.
 
The new set up gives better lip support resulting in a revitalised aesthetic appearance in both facial and profile views.
 
The larger teeth also fit the patient's face much better and the repositioning of the teeth now gives a more youthful appearance, showing the full length of teeth 12,11,21,22 in full smile position while showing approximately half tooth-length in relaxed smile position.
 
Finally, the new vertical dimension was established to give correct facial form and function.
 
At this point we entered a discussion with the whole team, including the patient, on the materials we would use to construct the final prosthesis.
 
Important aspects were:
 
1.  The feel of the restorations
 
2.  The aesthetics (youthful & bright)
 
3.  Overall symmetry (cosmetic)
 
After looking at the options we decided that this would be a perfect case for Pekkton.
 
We had been working with various polymers for many years on similar cases and had perfected a technique to integrate polymers, Ceramic & composites all in one prosthesis which we called the BDT bridge.
 
We had a detailed discussion with the whole team on why we should apply this technique. The main driving force was the properties of polymers. Pekkton in particular is extremely well suited for this type of application.
 
Planned Prothesis - Individual Ceramic units (e.max) cemented onto a polymer frame (Pekkton) with composite gums. (AnaxGum).

 

Pekkton Scientific data & Material benefits. 

 

These illustrations show some of the properties of Pekkton.

 

Fig 7. Pekkton has a similar MPA to cortical bone - advantageous for implant treatment.
 
Fig 8. PEKK (Pekkton) The Peek of Peek. Pekkton
sits at the apex of the High performance polymer pyramid.
 
Fig 9. Composite adhesion is strong with Pekkton - ideal for luting individual ceramic units to the framework.
 
 

 

Delivery of the completed bridge. 

After all the lab procedures were completed it was time to deliver the finished prosthesis to the Drs office. (Fig 10, 11, 12 & 13)

 
Fig 10.
The pressed Pekkton frame ready to cement the pressed and layered ceramic teeth.
 
 
 
Fig 11.
The layered e.max teeth are cemented to the Pekkton framework ready for pink composite layering.
 
 
 

 

   

 
Fig 12 & 13
The completed arch after the pink layering (anaxgum) ready for fitting.
 
 
 
The Fit appointment. 

The images below show the final result at the fit appointment. The whole team was delighted with the outcome and the patient was especially thrilled to receive her final prosthesis.

  

 
Fig, 14,15,16,17 & 18
The fitted Pekkton BDT bridge achieves a harmonious end result.
 
The new vertical dimension rejuvenates the patient's face while still looking natural.
 
The larger hand layered ceramic teeth look real, the patient also commented on how real the teeth felt.
 
The finishing touch with the hand layered pink composite really frames the overall natural appearance of the bridge.
 
The entire prosthesis weighed less than 20 grams!
 
In conclusion, Pekkton frameworks provide the patient with a lightweight, aesthetic, and extremely strong restoration that offers a shock absorbing property not found in traditional implant restorative materials.
 
All clinical work by Dr Richard Anderson
 
All Laboratory work performed by the technicians @ BDT Leeds.  More info @ www.beeverdental.com