A case of aesthetic makeover (I) with full porcelain bridge – Replacing missing teeth

September 7, 2014 by Dr. HonWei Ng

A lady came to our clinic complained that she wanted an immediate replacement of her front teeth that were just extracted a week ago due to gum problem. She said that she didn’t dare to go out of her house due to her disfigured appearance. She was sad and embarrassed

Pre-op01 Pre-op03

There reason why she lost her front teeth was due to deep-bite (her lower teeth were biting at the back of her upper front teeth) which result in stripping of the gum on the palate (traumatic occlusion). Eventually, this lead to periodontitis (gum disease) and loosening of her teeth. Sadly, she had to have her upper teeth removed.
After examination and assessment of her teeth, we came out with a few treatment plans:

  1. Correction of the occlusion (biting) by means of orthodontic treatment followed by orthognathic surgery to correct her jaw misalignment — which will takes her 2-4 years
  2. Dental implant to replace the missing front teeth — Required bone block to build back resorbed  alveolar ridge and the implant might not be lasting due to the occlusion problem
  3. A dental bridge from her canine to the other canine (a 6 unit bridge)

After discussed with her, she decided to go for the third option – a dental bridge. She preferred the zicornia type of material for aesthetic reason.
For a mean time to allow gum healing, we prepare a ‘vacuum formed’ denture which she used to cover the missing teeth.


A temporary denture


She wear the denture while waiting for the gum to heal

Final outcome, a 6 unit zicornia bridge was cemented onto her teeth…


Final result


6 unit zicornia bridge

Possible problems/risks for a dental bridge:

  1. Fracture bridge
  2. Possibility of devitalizing the teeth during preparation of teeth ending up needed root canal treatment.


How do we do it?…

1) Temporary denture

After extraction, she needed something to cover the gaps while healing took place. So, denture will be the best option as it was simple to construct and relatively cheap.
Due to her deep-bite condition, a conventional denture was not suitable for her to wear. Therefore, we prepared her a ‘vacuum-formed’ denture which used a plastic splint as base to hold the acrylic teeth.


A temporary denture


Back view


Denture in her mouth


2) Model planning

At the same time..  A study model was taken form patient’s mouth. It was used to construct back her teeth using wax.


A study model of the upper jaw


Wax was used to bulid back the teeth

Mock-up01The new teeth in biting position Mock-up03

The back view

The ‘new’ teeth were shown to the patient.
We were preparing  her a 6 unit zicornia bridge which involved her health left lateral and both upper canine.

3) Shade selection

Before preparation for bridging, the colour/shade were taken. To be as natural as possible, the colour of the crowns must be almost similar to the colour of the adjacent  teeth.



4) Teeth preparation

After the teeth were anesthetized, the upper canines and upper left lateral incisor were prepared.

5) Impression taking

A duplication of the teeth were taken and was sent to the lab technician for porcelain crowns fabrication.

6) Temporary bridge fabrication

A temporary bridge was made onto the prepared teeth base on the study model waxed up. The shape, postion of each teeth were check and adjusted.
With this bridge, the patient can really appreciate the final outcome of the bridge.  She was allowed to go back home with the temporary bridge.
She could show to her family and friends of her new teeth.


Temporary bridge on model..


And in the mouth

Temporary02The midline, smiling curve were checked Temporary01The incisal show when lips at rest


6) Zicornia bridge back from Lab Technician

The dental lab technician was instructed to follow every single detail of the temporary bridge.
10 days later, the bridge finally came back to be fit into patient’s mouth.
The fitting and margin were checked on the model before patient come.

Final08 Final06


7) Cementation of zicornia bridge

Patient came back for fitting and cementation of the crowns. After been anesthetized, the temporary bridge in the mouth was removed, and the teeth were cleaned.
Fitting, biting and colour of the bridge were all checked. And the patient was allowed to see the bridge in the mouth for the first time!!
After she was satisfied with the shape and colour of the bridge, it was cemented with Rely-X!!
Final Result (pic below)!!

Final03 Final02
Final05 Final04



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