Diagnosis:

Patient with wide smile line presented with periodontally involved teeth 5 to 5 UL, #15 teeth mobility 3. Heavy calculus

Patient Expectation:

I love to smile but my smile is not exactly pleasing.

Please fix my mobile teeth and help me eat and smile better

Treatment goal:

Remove teeth with mobility 3, debride and clean sockets.

Graft to maintain bone volume and height

Restore functionality with 5 to 5 UL Zirconia screw retained implant supported bridges

Screw retained prosthesis to allow removal and maintenance of underlying soft tissues periodically in consideration of patients oral hygiene.

Zirconia bridge with pink gums to recreate aesthetic smile in view of patients high smile line.

Improvement of patient facial profile.

No complaints of tmj issues, to maintain current jaw relation.

Patient presented with deep calculus

Very poor OH.

Non ideal smile due to movement of periodontally involved teeth

Diastema between 21 and 22

Full smile- notice high smile line

Full smile- notice Gummy smile, diaestima

Side view of full smile- 11 protruded outwards

Surgical considerations:

High chance of implant failure and peri- implantitis - managed by prophylaxis prior to and after procedure

-through debridement

-Reduction of bone height provides sufficient soft tissues to allow grafting of sockets and creating sufficient bone volume around implants.

8 neobiotech IS II Active fixtures installed, maxillary fixtures are fitted with Multi unit angled abutments to redirect screw channels to occlusal surface and allow passive seat of prosthesis with uniform path of insertion.

Sockets grafted.

Lips in ripose

Full smile- zirconia bridge fabricated by Neobiotech Cameleon 5-axis milling machine (6 years still in service)

Smile line redifined with pink porcelain on zirconia bridge.