Let’s look at the upper jaw—it’s no different apart from the bone quality. If we want to replicate what we do on the bottom on top, we have to be aware that the bone on the top is not as good quality as the bottom.
Different Conditions for Different Mouths
On the bottom is the most dense bone. Our natural teeth are short tiny little roots and yet they’re quite solid. In the upper jaw, the same teeth are much bigger—probably three times the size, in the back our molars have got three roots much like a tripod. So basically, our upper teeth and jaws are designed and built differently depending on the area and location that they’re placed. So when we’re doing implants we have to take that into account as well—for example, If somebody has all their upper teeth missing and they’re looking for something to replace an upper denture that’s loose and moving around.
On the lower, we started off with two implants because the bone here is very dense. We can put two implants in place and snap in a denture that’s going to work quite well. If we did the same thing on the top, over time the stress on those implants would tend to cause them to be lost. Will that happen with everyone? No, but if there’s too much pressure, someone who chews more or a bigger man who clenches their teeth—it may cause some problems with those implants. So typically, we would put in four implants to start with and right away we would join them with a bar.
Eileen—Faulty Dental Implants
She already had implants in place as well as teeth but she was having problems with the way the teeth were made and they were breaking all the time so she asked if I could do some alternatives to repair and fix them and that’s exactly what we did. When she came in we saw she’s got four implants on the top. She’s got this bar where the denture snaps in, but the way the bar was designed was such that the denture kept breaking and this is her upper bar.
The previous dentist tried to modify it to make it work and trim it to give more thickness of acrylic. Literally what we had to do was make a brand new bar and she now has a denture that snaps and it’s very solid so allows her to bite anything even a hardest or greenest of green apples and that denture doesn’t come out.
The disadvantage is she still has a full palate because if the palate was removed there’s too much tendency for that denture and those teeth to overstress the implants and there’s a great chance that she will lose those implants long term, so she still has to have a full palate. Where we can have implants in an over denture or a denture give a person great benefits is if we can go to six implants. So we’ll have three along the side here, three along the side there, and we have six implants and we join it with a bar.
And this one here is Ron showing his implants in place and showing his bar. That’s it in the mouth. This is his upper denture and the biggest thing you’ll notice, it’s like a horseshoe, there is no palate and this snaps in place. We can have three; we typically have five or more clips right in place. This is how it looks in the mouth and this is his smile afterwards. So we can do this with basic six implants on the upper and as you can see it looks very similar to the lower, except there’s six implants as opposed to four, there’s a bar, and there’s a denture. It looks like a lower denture because it has no palate. It’s like a horseshoe so it leaves lots of room for the roof of the mouth to be open. Room for taste and texture of food and room for speaking and so on.
Next, here’s another situation showing someone who already has a couple implants in place, had some health issues and as a result unfortunately caused almost all the teeth to be lost. But fortunately, the way implants are it had no effect on the implants and so we decided to do was to remove the remaining upper teeth that were failing. The one implant we were able to keep and on the upper we had converted this one also to a bar, an over denture.
And there’s the bar on the model, here’s the denture, there’s the clips, and this is the after picture that we had taken showing her new teeth in place and she was so thrilled her comment was “Thank you for giving my smile back.” She now had something that was very solid; it was not going to move around. She has no issues and as you can see in one of the previous pictures we also got rid of her lower partial and gave her some permanent teeth on the bottom as well.
Amy—Dry Mouth and Cavity-Prone
This is what Amy looked like when she first came in.
Actually, she came to us through one of these seminars. She’s had her teeth done and rebuilt at least twice and spent lots of money getting her teeth done. This was how she looked afterwards. She has an issue where her mouth is extremely dry and as such she develops cavities one after another. She’d already had her teeth rebuilt with crowns all around top and bottom. This first picture shows some of the crowns that are still remain but everything that was left was basically black and rotted right down to the gum line. There was no point trying to salvage or save these teeth, she would’ve gone full circle again.
So we talked about options she elected to go ahead with dentures on the top and the bottom that would snap in place, and that’s exactly what we did. Took the teeth out, put the implants in the same day, put an upper and lower bar in place, and then made an upper and lower denture. This is a close up of her before and then of course afterwards when we had done the treatment. And for her it was huge, she couldn’t eat and chew.
She was the tiniest little person and she could never put on weight and her comment after she finished was “this is wonderful. I’ve been able to gain ten pounds” and most people may not be happy with that but for her who somebody who couldn’t eat and chew well that was wonderful and as she said “This special moment will be an unforgettable experience the rest of my life.”
Overdentures in The Upper
Uppers we can do these overdentures where they snap in place but we typically we start with four implants as opposed to two, move to six if we want to get rid of the palate, and we can also do permanent teeth. And much like on the bottom where we added a couple implants for the molars, we can do the same but we need to add a couple implants for the back molars.
And just like on the bottom where we started off and we took a denture and we modified it and screwed it into place, the same thing can be done on the top and was done in the early stages of implant dentistry. Once again, I don’t do these screwed in dentures much in my practice. I find there’s a lot of maintenance and problems with them as you’re going to see in this next picture here.
Joan—Rapid tooth wear
This is Joan.
She came in what you see on the x-ray is some implants with a bar in place and looks like an over denture situation, but it’s really not. This is a denture that is screwed in place. This is how it looks in the mouth; you can see the little holes where the screw access is.
The biggest concern was this was only done a few years earlier and she was already wearing down the teeth very quickly. Her implant treatment had been done about 16 years ago and I actually saw her about 10 years ago today to actually fix and repair her teeth and what we had done is taken those teeth off, stripped off all the acrylic, and just basically remade the teeth. Her implants were perfectly fine but she was wearing down her teeth very quickly because she could chew and bite as hard as she could with natural teeth and nothing had been done to protect the plastic or acrylic which is much softer than tooth enamel, porcelain, or anything else. The other problem with these is on the bottom if you remember this flange removed and there was a space made underneath here so the person can clean readily underneath.
At first, the same thing was done with these upper dentures. The problem is on the upper if we do that as we talk and eat, air tends to go through because of the way we make sounds and our lip tends to flutter and vibrate as we make certain sounds. Plus food tends to trap up there which becomes a real annoyance. So the dentists when they first did this had to take those teeth back out and put the flange back for those reasons and also to provide lip support for the upper lip, but now makes it very difficult to clean and maintain that. And unlike in one of the earlier cases where I showed that some cases these can go with very little maintenance, we do need to clean around them at least a little bit.
We do need to clean around them and if we don’t gums can get inflamed and as dentists if we can’t even get in there to see what’s going on it makes it very hard for us to evaluate how healthy are the implants and how well are they being maintained.
So I don’t do these types of teeth because they have some issues with them. There’s better ways of doing it. This last picture shows the before and after how much the teeth had worn down and how they are now. She’s not going to go full circle because we’ve given her something to protect her teeth at nighttime, so she doesn’t grind away the teeth.
If someone wants to have permanent teeth and they want to have something that is close to natural as possible, in my opinion, a better way of making permanent teeth is not to do dentures that are screwed in place but to treat these implants as if they’re natural teeth and to make permanent crowns and bridges on top of them. Still the same number of implants. We still only have eight implants but now we’re doing a different type of teeth and the teeth we’re doing are crowns and bridges.
This is one showing an existing bridge on natural teeth that was failing due to gum disease. This was done over 13 years ago today. All these teeth had to go other than the lower front. Took the teeth out, we had to do some grafting to build up the bone. That’s how it looked before and this is how it looks afterwards. You really wouldn’t know it unless you saw an x-ray whether these were natural teeth or these were implants underneath. There’s an x-ray showing the natural teeth with the crowns in place and here’s the x-ray with the implants and the crowns in place and as you can see we not only did the upper we did the lower and there’s the lower that’s a completed and the lower front teeth are still her natural teeth.
In the back areas are crowns and bridges on top of implants, and there is the before and after. This was five years later and it’s been now well over ten years since we have done her treatment and everything is still in good condition.
Another situation, this is Joyce.
She was 70 years old when she came to see us. She had had upper dentures for over 35 years and lower dentures for almost as long and she was fed up. She was having real difficulties being able to chew and eat with them. She wanted to have permanent teeth. She was going to go through implants. She wanted something that was permanent. So we put eight implants in place. We had to do some bone-grafting, top and bottom. We put eight implants in place, we put some implants in the lower bottom left and right as well. This is her upper teeth when they were done and this is her lower teeth. We were able to maintain her natural teeth on the bottom front and now she has permanent teeth that are fully functional. She brushes and flosses with them as she would normally.
This was her smile before. One of her complaints was nobody can see her upper teeth. One thing that happens as we get older is, we lose elastin and everything starts to droop and sag. Gravity seems to take hold of everything including our lip and when we were done, we were able to get her to show some teeth as she talked and smiled. Next one, here is Mario also with some gum problems. He’s losing all his teeth all his teeth are loose and as you can see the gums have receded and there was really nothing that could be done to save these teeth. So they all had to come out and we did this in a way where all the teeth came out that very same day we put the implants in place and that very same day we gave him some temporary permanent teeth. We had to wait a little bit and have him eat a softer diet while those implants healed so that would allow the bone to fuse to them because if you remember we can’t allow those implants to move while the bones healing.
This is how he looked in the film before and then how he looks now afterwards and his close-up before and afterwards, and here’s Mario before and after as well. Before he didn’t like to smile or show his teeth, now basically you can’t stop him from smiling. He’s just so happy and proud with his teeth and feels so comfortable and confident.
This is Denise.
By the time Denise came to see us she already had upper dentures and lower dentures. She also had gum disease. Someone else had taken her teeth out initially though and told her that she had to wait six months for the bone to heal and unfortunately, she had an issue because her son as getting married in Europe and she couldn’t function, and eat and chew with these dentures and she was beside herself. “How am I going to get to this wedding and look good for my son who’s getting married?”
Came to a seminar, realized we’re doing immediate implants and immediate teeth and said, “Is this possible for myself. Do I really need to wait six months?” She came in, took a look at her x-ray. She had good bone volume everywhere, little bit of bone grafting was required. I said, “There’s no problem.” We had a few months to work with before she left on her trip and we managed to get the implants in place, and we gave her permanent teeth. Put in implants, top and bottom.
Within a week, we gave her the final temporary teeth. She went off to Europe, saw her son married, able to chew and eat, function no problem. She came back shortly thereafter and we evaluated the implants for healing. Once we found that they were fully healed, we made her permanent teeth and this is what you see here.