DENTAL IMPLANT Case studies by Dr Adam Glassford

The following pictures are all before and after cases prepared and completed entirely by Dr Adam Glassford and his ceramic technician. No photo re-touching or digital enhancement has been used whatsoever

2 Central incisor cosmetic implants

This case shows a 2 tooth denture replacing the upper central incisor teeth. The patient disliked the denture and came to see me to consider implants as a permanent replacement.IMG_7877IMG_8546
Two individual dental implants were placed in the central incisor positions and you see the Zirconia abutments fitted that retain the fixed crowns.IMG_8699
The layered ceramic crowns are permanently bonded to the zirconia abutments as two individual teeth. Flossing is possible between the crowns just like natural teeth.
Final result showing harmony with the smile and lip line.

Cosmetic crowns, veneers and implant crown

the before pictures here show a slightly crowded upper jaw and missing adult canine teeth. The upper right central incisor tooth was fractured and needed to be removed and an implant placed
the after pictures here show how the misshapen teeth have been transformed with natural looking crowns and veneers. The upper right central incisor was replaced with a single tooth implant, zirconia abutment and matching cosmetic crown. Important points to note here are the zeniths of the central incisor teeth which match each other perfectly. This can be very hard to achieve when a natural tooth is next to an implant. The shade and characteristics chosen reflect a natural look and the patient was particularly keen to avoid a false or overly white result.

Single cosmetic implant crown

this missing single lateral incisor was replaced with a dental implant and restored with a zirconia cad cam abutment and single cosmetic ceramic crown. Natural shades and characteristics were incorporated into the crown to blend with the untouched adjacent teeth. If you look closely you can see many gradations of shade within even just a single crown. Natural teeth have these features so we strive to copy them in our cosmetic restorations. Particular attention was paid to replicating the natural height and contour of the gum. If not done properly, gum levels can rise on implamnts and fail to match the adjacent teeth. I always aim to place the gum level at the correct height where possible.

Single cosmetic implant 2

This very challenging case shows how it can still be possible to perfectly match a single central incisor implant and crown ensuring that the gum level and aesthetics are perfect. I ensure that every detail about the crown is a faithful reproduction of the natural tooth including shape, shades and surface textures. You will also notice how the gum level is perfect and displays health.

Single upper incisor in an aged dentition

This tooth was lost due to trauma and was replaced with a removable partial denture which the patient did not like
In order to create a tooth that matches the adjacent one for length and gum level, bone mineral was added. This after picture was taken 1 week after the crown was fitted and as the gum matures, the profile will continue to improve around the neck of the tooth.

Multiple implants replacing full upper set of teeth

This case shows a failing set of natural upper teeth replaced with an immediate implant bridge. The second picture shows the immediate provisional bridge in place whilst the implants healed with the bone. After this was fitted onto an initial 4 implants, 6 further implant fixtures were placed to support upper back teeth implants.
The final upper jaw had 10 implants in place, 4 at the front and 3 either side at the back. This number was necessary as additional sinus grafting was necessary and ideally one implant per toot is used at the back of the mouth in such cases. The total treatment time was around 9 months and again it was the sinus grafting that dictated the timescale. Again in this case, as the patient was in her late 60’s she wanted a very natural look to the teeth and requested features that were sympathetic to her age. All of the upper teeth shown in the above picture were created from ceramic and fitted to the implants. The lower teeth are the patient’s own.

Implants to replace a partial denture alongside cosmetic crowns

The starting point here is an old partial denture that had been worn for many years and some old crowns on the upper front teeth. The patient decided that she would like a permanent fixed replacement of the denture and a fresher younger look to the rest of the smile
The case was planned using models of the teeth and numerous photographs looking in particular at the smile line and shape of the lips at rest and at smile. Once the implants had been placed upper right and upper left, the trial smile was fitted over the top as shown above. This allows the patient time to get used to the new shape and contours of the teeth before the final work is created. The trial smile can be altered as many times as the patient wishes until they are happy with the final look. The customised trial smile is then translated into the final ceramic work
The final result reflects the patient’s wish list for a healthy fresher look that still looked natural and not out of place given her age.

Sinus grafting, multiple implants and crowns

This case was referred by a dentist who had tried hard to save the patient’s teeth over many years. She had suffered gum disease of the upper back teeth with significant bone loss.
The patient was also unhappy with the appearance of the old crowns on her front teeth. A comprehensive plan was formulated to remove the failing upper back teeth, grow new bone using sinus grafting then place implants to replace the missing teeth. The front teeth crowns were also replaced.
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This full mouth x-ray shows the bone loss around the upper back teeth
This full mouth x-ray shows the upper implants placed as well as new bone grown by the sinus grafting technique. In sinus graft cases it is usual to use one implant per tooth for additional strength.
This picture shows the titanium abutments fixed to each implant shortly before the fixed teeth are permanently bonded into place.
Here the new crowns have just been fitted on the upper teeth along with the new implant bridgework at the back of the mouth.
The look of the final smile mimics the original but with a new fresher look. Overall treatment time was 12 months from start to finish.

Implant bridge to replace failing upper front tooth supported bridge

The starting point here is a bridge supported on failing natural teeth. You can see the dark red abscess above the upper incisor teeth that has resulted from the failing support teeth
Because infection was present, the teeth supporting the bridge had to be removed and initially a temporary denture fitted as seen above. This was in place for a couple of months before the gums had settled enough to allow 2 dental implants to be placed.
2 substantial implants were placed and used to support this 5 tooth implant bridge. The bridge is permanently fixed in place over the silver coloured titanium abutments. Initially the gums ‘blanch’ from the local anaesthetic as seen above but this goes after a few hours and returns to a normal natural pink colour. Here again the patient was happy with the shade of her natural teeth so we blended the colour and texture in to match

Implant overdenture; an economical implant option

The starting point here was a set of failing upper natural teeth that had become loose over the years. The patient wore an ill fitting partial upper denture so was accustomed to the feel of a denture in her mouth. Implant over dentures work best in patients that have some experience of wearing even a small plate initially.
After removing all the failing upper teeth and fitting an immediate temporary full denture the mouth was left to heal for 3 months. After this time 4 implants were placed in the upper jaw and these can be seen as the gold coloured studs which are in fact a press-stud like fitting on each implant which connects precisely into the black cup seen on the second picture. This creates a very firm clip which retained the implant over denture. The over denture still needs removing several times each day for cleaning especially after meals but is firm when speaking and chewing
The final result shows the lower teeth cleaned by the hygienist and whitened and the upper implant over denture in place. The shape and colour of the teeth is chosen with the patient and here again we have aimed for a nice natural healthy look within the normal light shade range