1. As a first stage, a new set of dentures were constructed to establish the patient's preferred tooth arrangement and the cosmetic goals for the case.
2. Once Dave was wearing a set of teeth that looked exactly as he wanted the final implant reconstruction to look, a copy of the denture was made using radio-opaque teeth to mimic the required tooth positions. These teeth are made to show up on X-rays and on CT scanners but look a little strange to the naked eye as they are brilliant white and do not come in a full range of shapes and sizes. However, they are only for wear during the scanning process to establish the required tooth spacing on the scans!
3. Excerpt from the computer software /scan results: This view gives an example of the planned relationship between the radio-opaque teeth used for the scan and the 6 implants planned to support the reconstruction.
4. Excerpt from the computer software /scan results: This view shows something of the planned relationship between the implants and the underlying bony anatomy.
5. From the CT data and the planning software on the computer a drilling guide has been generated using the digital data. This will fit into the patient's mouth at the surgical visit and lock the drills into the same trajectories as have been determined on the computer software programme at the planning phase.
6. Using the CT data, the laboratory have also been able to make and supply the temporary set of teeth that will screw down onto the implants once they have been fitted in their pre-determined positions. In this case, the temporary teeth have been supplied on a translucent detachable plastic base which helps ensure that the teeth are seated as planned in the mouth.
7. The temporary teeth are tried in the mouth prior to surgery (the removable translucent plastic locating carrier/ base can be seen extending over the front of the teeth).
8. The drilling guide is tried in the mouth prior to surgery.
9. View of one of the implants about to be inserted after the drilling phase has been completed. The bone bonding section of the implant is a matt grey colour. The highly polished metal section holding the implant is a detachable part by which the implant can be picked up by the surgeon (this section is known as the “implant carrier”).
10. All 6 implants have been fitted as planned. The 6 implant carriers line up through the centres of the drilling guide openings confirming they have been fitted correctly as planned.
11. The 6 implants in place immediately subsequent to completion of the surgery. With this type of “key-hole surgery” there is minimal postoperative bleeding since the implants closely fit into the surgically created sockets.
12. The temporary set of teeth in place immediately after the surgery. The patient can eat a light meal once the local anaesthetic (numbness) has worn off.
Dave attended requesting a new full set of teeth for both upper and lower jaws. However, due to commitments outside the country and difficulty in being sure exactly when he would be able to re-attend for subsequent visits, it was important to him that he should have teeth fitted on the same day as the actual surgery. The case shows examples of “Same-day-teeth” for both the upper and the lower jaw using CAD/CAM (computer driven) technologies.
These types of cases can be more complex and do not suit all situations. Generally speaking a temporary set of teeth can be fitted initially on the same day as the implants, with impressions of the healed implants taken some time later (usually after a few months). The temporary teeth are usually made in plastic so as to be easily modified as required on the day they are fitted. The final set of teeth normally is constructed using some form of metal subframe (eg Titanium, Gold alloy or Palladium alloy) for added strength and durability (this also enables the definitive set of teeth to be made in a finer (thinner) section and they therefore tend to be a little less-bulky than the initial temporary plastic set.
In this case the upper jaw was planned following a CT scan to allow computerized simulation (“virtual planning”) and computer guided surgery on the day the upper implants were fitted.
13. Photo of the biting surface of the temporary bridge (taken using a mirror).
14. The final set of teeth are made and fitted 3 months later. In this case the fitting surface (the part in contact with the gum) was made in surgically pure Titanium (this metal undersurface cannot be seen once the bridge is screwed into place).
15. An X-ray taken 2 months later showing the upper reconstruction on the 6 implants (x-ray taken while the surgery for the lower jaw was in progress).
16. The plastic temporary bridge for the lower reconstruction – due to be fitted on the day the lower jaw implants are fitted (front view).
17. Similar view to 16, but from above.
18. View of the temporary bridge in place (photo taken one week after the implants were fitted).
19. The final bridge was made some months later with porcelain teeth on a precious metal alloy framework.
20. View of the biting surface of the final bridge. The bridge has screw holes to allow it to be screwed down onto the implants. These will be filled in using a tooth-coloured filler once the bridge has settled in.
21. View of the final bridge screwed into place.
22. View of the final bridge from the front (photo taken on the day the bridge was fitted).
Case Histories 
