Georgia Reconstructive Dentistry

Atlanta Tooth Replacement - Reconstructive Bite Bridgework

Long term use of dentures and partial dentures, as discussed elsewhere on this website, can cause unusual wear and tear issues that frequently lead to bone loss events that can collapse the bite and potentially worsen overall dental function.

Maxillary Implant Placement
Dental Implant Placements
The picture series presented here demonstrates the creative combinations of dental products and technologies used by Dr. McFarland that effectively replace a quantity of lost maxillary jawbone height and width that can commonly occur with extensive use of partial dentures but in a fashion that assures the same stability and long term function.

The patient has a few molar teeth that are structurally sound and require only minimal treatment. The implants are strategically placed by Dr. McFarland to take the best advantage of bone height and width that will assure a firm foundation for a planned Porcelain bridge product.

Implant Alignment Review

Implant Alignment Verification

Special "transfer" (plastic composition) abutments are temporarily attached to the implants to provide an accurate "capture" of implant positioning for fabricating the bridge. Dr. McFarland's verification of the angles used for each implant becomes the basis for custom bridge abutments.

This particular assessment assures that the final bridge design and custom abutments do not cause unusual lateral forces upon any particular implant that can lead to implant failure. Failure to address possible extreme values in angulation and/or poor abutment selection is frequently a factor in an implant failure with a new prosthetic.

Temporary Plastic Abutments

Temporary Abutments

Plastic abutments are used, temporarily, to facilitate the design, fitting and final adjustments for a custom titanium framework that compensates for the small variations in bone height along the arch.

The "fitting" of the prototype, or bridge framework, is adjusted as necessary to create the desired, identical results on the stone model used in treatment planning, as well as how it "fits" the patient's overall jaw structure.

The adjustment process is incremental. Modifications are very small at each step to prevent the occurence of the bridge framework being "over-modified." Dr. McFarland's attention to detail during this process assures the bridge will have the proper fit and feel desired by the patient.

Final Titanium Abutments

Final Abutment Milling

Tissue characteristics of the patient and overall bridge design were factors in selecting titanium as the ideal material for abutments.

The temporary abutments assured that variations in shape, height and width are accurately transferred to the metal abutments.

The patient's new bridge is cemented to the custom abutments.

Screw retained bridgework is also available for patient's who require routine removal of the bridge for oral health maintenance issues.

Working Prototype Bridge Framework

Function First - Cosmetics Second

As can be seen in the adjacent photo, there are some variations in bone height that also create variations in gum tissue height.

Aesthetic concerns are quite different for each patient. Male patients tend to focus on function first, then cosmetics. Female patients, conversely, tend to want the best of both, but with function being close second.

Age, however, tends to be a major influence. As a general rule, older patients focus on getting the best function possible. Bone and soft tissue graft surgeries are sometimes avoided due to the need for additional healing time, cost factors and certain medication regimens that may prolong a given treatment plan.

Bite - Occlusion - Vertical Dimension Analysis

Occlusal Plane Assessments

Many accomplished cosmetic and reconstructive dentists, along with most Prosthodontists, will use a Facial Plane Relator device as shown here.

This measurement device is used frequently by Dr. McFarand during different stages of treatment and design of the prosthetic (e.g., denture, bridge, partials) to assure the patient's "new bite" is parallel to the patient's interpupillary line (imaginary horizontal line that connects our pupils).

It also assures that the Midline (space between the two front teeth) is centered perfectly beneath the nose.

There are too many unfortunate stories of patients who have undergone complex treatments where the Midline Centering was performed with guesswork... that can create a beautiful upper arch of new teeth that is off center.... and very noticeable.

This type of technical error is a non-event in our practice.

Acrylic Try-In to Final Porcelain

An acrylic temporary bridge is used for a short time that permits minor adjustments in tooth sizing, color shading and bite adjustment. The use of temporaries assures the patient that there will be no cosmetic or functional surprises with the final restorations.

Porcelain Bridge Product
Color, translucency, shading, smile line, fit and feel should be as perfect as defined by the patient.

Multiple try-in's are used as necessary to give the patient ample time to test and retest the overall bite, fit, feel and cosmetic value of each modification.

Once a consensus has been achieved between the patient and Dr. McFarland with the temporary bridge, the technical values of the modified temporary bridge is used to fabricate the final porcelain product.

Unique Bridge Characteristics

This patient chose to avoid additional bone and tissue grafting surgeries that could have been implemented to create a level span of maxillary bone and gum tissue that would have added a cosmetic symmetry but have little or no impact on overall function.

In particular, one of the porcelain tooth structures is a bit taller than the rest of the bridge.

Mirrored Arch Reconstruction
Because the patient had the type of smile that would not show the gingival arching across the top of his bridge, this unique configuration produced a structurally solid prosthetic but with a cost savings that was considered significant by the patient (no additional graft surgeries).

The adjacent mirrored view of the rehabilitated arch reveals a excellent symmetry and healthy bone width.

Masculine Smile Line Reconstruction

Different smiles for different folks....

Prosthodontic - Cosmetic Outcome
Males, as a general rule, prefer to have tooth sizing and shaping characteristics that produce a smile effect that is minimally contoured.

Females, on the other hand, tend to prefer having a more contoured effect applied to the incisal or biting edges of the upper teeth that tends to follow the contour of the lower lip.

This seemingly unimportant cosmetic detail can have great impact upon the final treatment outcome. The advantage of using temporaries assures each and every patient that, for all practical purposes, no cosmetic detail is left unaddressed.

Treatment Summary

Prosthodontic design of a custom titanium framework porcelain bridge was used in conjunction with strategically located implants that not only replaced lost dental function caused by extensive use of partials.... but effectively addressed certain bone tissue characteristics without the need for additional bone and soft tissue grafting procedures.

Bone Graft Questions?

Call our office at (770) 623-0930 to schedule a consult with Dr. McFarland to learn more about the opportunities to use specific treatment and technology combinations that may enable a patient to have advantages that many dentists may not be able to offer.

Patients with specific questions about any of the material on this page are invited to contact us directly with our on-line Ask The Dentist form. Dr. Marie or Dr. Chris will respond directly with the answers and information you are seeking.