Two-tooth implant placement and full-mouth crown prosthetics

We first met the patient about a year ago. She came to our clinic for professional oral hygiene and also complained about missing 6th and 7th teeth in the lower jaw on the left. After a CT scan and clinical examination, we found that some of the teeth that had previously been restored with prosthetic restorations had already been endodontically treated. Almost all teeth were covered with crowns, partial crowns, and veneers. The restorations were relatively old but generally in satisfactory condition. The amount of bone tissue allowed implant placement. Therefore, we suggested placing dental implants using the two-stage implant placement method in the area of the missing teeth, followed by prosthetic restoration with all-ceramic dental crowns.

The patient agreed to treatment. At the stage of surgical planning, she was concerned about possible pain and considered having the procedure performed under general anesthesia ("narcosis"). The doctor explained the options for local anesthesia, described the course of the procedure, and answered the patient's questions. After the consultation, implant placement under local anesthesia was chosen. The procedure was quick and comfortable for the patient.

After completing the "all-inclusive" implant treatment, the patient returned to us after some time with a request to replace the old prosthetic restorations in the anterior area, as she wanted a slightly more elongated tooth shape. The doctor suggested performing the treatment with a preliminary try-in of a mock-up model to consider all wishes regarding the size and shape of the teeth and to allow the patient to try on the future restorations and wear them for some time. Due to a busy schedule, the patient declined this stage and noted that she was satisfied with the tooth shape; she only wanted them to be slightly longer and completed within a short timeframe.

Several days after the restorations were fixed, the patient returned: the new result did not fully meet her aesthetic expectations. She realized that she wanted not only longer teeth, but also lighter, wider, and visually larger teeth in the smile zone. This time, the doctor strongly recommended a mock-up try-in, and the patient agreed that this stage was necessary. The work had to be redone, but after the shape and size were approved again, the result fully satisfied the patient.

The entire treatment journey consisted of the following stages:

        STEP 1
        
Examination and consultation with the doctorThe doctor examined the oral cavity, analyzed the CT data, listened to the patient's wishes, and proposed a treatment plan.

        STEP 2
        
Dental implant placementThe surgeon placed 2 implants in the area of the missing 6th and 7th teeth and then sutured the wounds. The procedure lasted up to 20 minutes. The patient considered having the surgery under general anesthesia because of fear of pain. After the options for local anesthesia and the course of the procedure were explained, surgery under local anesthesia was chosen. During implant placement, the surgeon immediately installed healing abutments. This helped form the gingival contour and prepare the tissues for future prosthetic restoration.

        STEP 3
        
Removal of surgical suturesSeven days after the procedure, the patient was examined and the surgical sutures were removed.

        STEP 4
        
Placement of Ti-base abutmentsOne and a half months after the procedure, the patient came for a follow-up examination. The doctor checked the integration of the implants and assessed whether prosthetic treatment could begin. Before scanning the jaws, Ti-base abutments were placed. The doctor obtained digital impressions of the jaws and sent the data to the laboratory.

        STEP 5
        
Digital design and millingThe future prosthetic restorations were designed using computer software. The prosthodontist sent the data for milling. Anatomically accurate and aesthetic ceramic dental crowns were fabricated on a Dentsply Sirona CAD/CAM milling unit.

        STEP 7
        
ConsultationAfter some time, the patient returned to our clinic with a request to replace the old prosthetic restorations. During the consultation, the treatment plan was approved. The patient declined one of the stages — the mock-up model try-in — due to lack of time.

        STEP 8
        
Taking impressions of the existing restorationsThe doctor took silicone impressions of the existing prosthetic restorations. The resulting silicone key was used to transfer temporary restorations while the ceramic crowns and veneers were being fabricated. After that, the doctor removed all dental crowns and veneers. Digital scans of the prepared teeth and jaws were taken for the subsequent fabrication of the restorations.

        STEP 9
        
Transfer of composite material for temporary veneersUsing the silicone key, the doctor transferred composite material into the oral cavity. This was a temporary measure performed so that the patient could feel comfortable in everyday life and eat while the veneers and crowns were being fabricated. All work was completed in one visit. The patient went abroad and was expected to return in a week for fixation of the permanent crowns.

        STEP 10
        
Digital design and millingThe doctor designed new restorations in digital software, taking the patient's wishes into account, and sent the data for milling. Dental crowns and veneers were fabricated on a milling unit. To give the restorations a natural appearance, stains and glaze were applied. To fix the glaze, the crowns were placed in a special furnace and processed at a high temperature.

        STEP 11
        
Removal of temporary composite veneers and placement of permanent crownsWhen the patient returned from abroad, the doctor removed the composite material that served as temporary veneers and prepared the teeth for permanent prosthetic treatment. The doctor fixed the ceramic veneers and crowns with permanent dental cement. After this, the treatment could have been considered complete, but our cooperation did not end there.

        STEP 12
        
Follow-up consultationA few days after the permanent prosthetic restorations were fixed, the patient came to our clinic with a request to change the smile design, as she wanted an even larger tooth size. The patient had no complaints about the completed work and understood that the situation was related to declining the preliminary mock-up model try-in. This time, she agreed to the try-in, and we started the prosthetic stage again.

        STEP 13
        
Fabrication of the mock-upThe doctor scanned the jaws with the existing restorations and then designed the future teeth, taking the patient's wishes into account. After the digital 3D model was approved, a mock-up model was printed. Using composite material, the doctor transferred the mock-up model onto the existing restorations in the oral cavity. At this stage, the shape, size, and color of the teeth can be evaluated once again. The patient was fully satisfied, so we moved on to the next stage.

        STEP 14
        
Tooth preparation and removal of old restorationsThe old restorations were removed, and the teeth were prepared in the areas where this was necessary. The doctor obtained digital impressions of the jaws and prepared teeth. After the data were transferred to the digital design software, new restorations were designed based on the approved mock-up model.

        STEP 15
        
Milling of new crowns and veneersThe finished model was sent for milling, after which new crowns and veneers were fabricated for the patient. The finished restorations were stained, glazed, and these materials were fixed in a dental furnace at a high temperature.

        STEP 16
        
Crown fixation by the prosthodontistThe prosthodontist fixed the new crowns in the oral cavity with dental cement. At a follow-up stage several months after fixation, the patient was satisfied with the result.

        Summary
        
The overall treatment journey lasted approximately 1 year and consisted of three main parts: implant placement in the area of the 6th and 7th teeth with subsequent prosthetic restoration — 1.5 months; the first stage of aesthetic prosthetic restoration in the smile zone — 10 days; and the repeat prosthetic stage after approval of the mock-up model — 10 days.
In total, the treatment included 2 implants, 4 veneers, and 24 crowns.

Implant placement and crown prosthetics

Maksym Makarenko

Examination and consultation with the doctor

Dental implant placement

Removal of surgical sutures

Placement of Ti-base abutments

Digital design and milling

Fixation of crowns on implants

Consultation

Taking impressions of the existing restorations

Transfer of composite material for temporary veneers

Digital design and milling

Removal of temporary composite veneers and placement of permanent crowns

Follow-up consultation

Fabrication of the mock-up

Tooth preparation and removal of old restorations

Milling of new crowns and veneers

Crown fixation by the prosthodontist

Book a consultation with a dentist

Tooth restoration without implants

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Patient documents