BEFORE with dentures

BEFORE without dentures

Patient wanted to improve appearance  and comfort.  She wanted “permanent, non-removable, replacement teeth”, but did NOT want dental implants.
She wanted to avoid the risks of implant surgery that probably would have included bone grafting.

Dr. Perlmutter used his ingenuity and experience to design fixed bridges, attached to existing, non-mobile teeth.  This was done with minimal cutting of healthy enamel, by using “internal retention”, a concept that Dr. Perlmutter has used successfully many times.  It requires doing root canal treatment for healthy teeth.

AFTER with bridges

AFTER with bridges

Lower anterior bridge was made first.

This view shows how teeth were
prepared for bridge to be made.

This is a try-in, before porcelain was added to the metal.  There are lingual metal retainers on 4.2 and 3.3, with full crown and cast metal post for previously discoloured 4.1.  All healthy labial enamel was preserved for 4.2 & 3.3.
Patient is still wearing her upper partial denture.

Lingual view.

Bridge fits on cast, before being
bonded to teeth.

Upper long-term, temporary bridge was made, using non-precious metal with acrylic and denture teeth.  This was cemented temporarily, to be easily removed by dentist, but not removed by patient.  Upper denture was no longer needed.  Patient was then free to criticize any aspect of this temporary bridge.  We remade & adjusted it until she was satisfied with appearance and comfort.  Then we knew how to make the final porcelain-on-metal bridge(s).

See posts that fit into root canals of 1.3 & 2.3, allowing labial enamel to be preserved.  (Internal retention concept)  1.7 does have a full crown (external retention), because of much previous filling in this tooth.

In the lower arch, the anterior porcelain-on-metal bridge is completed, but silver fillings in 4.4 & 4.5 will later be replaced with composite resin.

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Lingual surface of incisors was repeatedly adjusted until patient became comfortable with tongue and speech.   Note that this is one piece, supported by 4 teeth.  See how bridge rests on lingual of 1.3 and 2.3, with posts extending into root canals.  See how much enamel was not cut away.  The occlusion on 1.3 & 2.3 was preserved.  The final, will consist of 2 separate bridges, supported by 5 teeth.

Posterior bridge will be bonded to supporting teeth 2.7 (note preserved enamel) 2.3 and 2.5 (with full crown because of previous amalgam and buccal gingival defect).

This bridge provides the 2.4 & 2.6
(bicuspid size) pontics.

2 BRIDGES ARE COMPLETED.

This was a complicated, demanding treatment case, requiring co-operation between patient, Dr. Mel Perlmutter and Talisman Dental Laboratory.  The bridges had to fit well, function well, feel comfortable to patient, and meet the high esthetic demands of all of us.  With all modesty aside, we all did a terrific job. 

My only regret is that patient doesn’t want her full-face photo displayed here on the internet.  She has a beautiful face to complement her improved beautiful smile.