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Cosmetic Dentist Troy Michigan MI Implants
Michigan Comprehensive Rehabilitation
Troy Porcelain Reconstruction Dentistry
Ara Nazarian, DDS
Adult Reconstruction
1857 East Big Beaver Rd
Michigan Dental Center
Troy MI 48083
(248) 457-0500
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Troy Advanced Comprehensive Full Mouth Rehabilitation

Total Teeth and Tissue Replacement

A video - slide presentation of the treatment plan discussed on this page can be be reviewed here.

The patient featured here had a significant history of teeth and connective tissue damage along with the threat of bone loss associated with advanced periodontal disease.

Meth Mouth Xerostomia
Catastrophic Drug Induced Deterioration

Destructive Xerostomia and Periodontitis

The adjacent picture reflects the amount of tooth destruction and significant bite issues. For many patients, while there may be different causal factors for the onset of tissue (gums, teeth and bone) deterioration, the long term cumulative effects create a result that is attributable to multiple diagnoses (gum disease, xerostomia, enamel demineralization, acid damage, etc.

When individual tooth structures become severely compromised, opposing teeth that are "healthier" can accelerate wear, tear and failure of the diseased teeth. Fortunately, for this patient, deterioration occurred at a pace that minimized bone loss.

Upper Arch Damage
Maxillary View
The adjacent picture readily shows, rather surprisingly, the ample width of the bony ridge. Such a ridge can accommodate a custom denture or a more advanced treatment that includes dental implants and permanent bridgework.

The loss of nearly all of the upper teeth has caused a considerable bite collapse. The ability to eat normally and comfortably is gone.

The next photo reflects multiple tooth loss despite still having a somewhat healthy ridge of bone (like the upper jaw).

Mandible
Mandibular Damage
Although there are losses of bone associated with certain tooth structures, the deficiency is more related to height... rather than width.

Teeth Replacement Choices

To maintain upper jaw health (specifically the bony ridge) extractions are required to remove remnants of tooth roots still in place. Although the lower jaw still has teeth, efforts to conservatively treat diseased teeth (try to save them) would be costly with low predictability for long term success.

Fast Removal of Teeth
Extraction Forceps

Minimally Invasive Tooth Extractions

It is probably fair to say that everyone is fearful of anticipated pain and discomfort of a tooth extraction. Multiple extractions serve to "multiply" that perception.

While many patients (and even some dentists) may believe that sedated oral surgery is required to remove all teeth..... Dr. Nazarian is one of the few full service dentists that has specialized minimally invasive instruments and protocols for eliminating discomfort while achieving results in a matter of minutes (no invasive surgery).

No twisting and yanking.....teeth literally pop out, rapidly.

20 Minute Edentulation
32 Extractions in 20 Minutes
The adjacent photo is a representative example of what can be achieved for most patients. All teeth are extracted in less than 30 minutes.

No trips to an oral surgeon. Patients have their choice of Oral or IV Sedation protocols to assure maximum comfort and convenience.

Immediate Extraction Healing

Because the patient wanted to maintain optimal bone health, he elected to have socket grafts performed on nearly all of the extraction sites. A socket graft involves placing bone graft material into each extraction hole with gum suturing to seal each site. Bone regeneration begins immediately with little to no risk of infection.

Although extraction sites will heal and regenerate bone independently, the process is much slower and can delay overall treatment goals.

Optimal Bone Health

Post Op Socket Healing
Extraction Socket Healing after 3 weeks
The fundamentals for nearly any treatment used to replace teeth includes a variety of patient choices to halt bone loss, conserve bone loss and even rebuild bone loss. These patient choices are related to what type of tooth replacement is desired.

Since ordinary, unsecured dentures have a long term effect of creating additional bone loss, this option was eliminated immediately by the patient.

Being middle-aged, the patient was focused on having basic dental function again AND having new teeth that looked and felt natural that were not removable. The idea of being able to eat literally anything he wanted just as he had during his younger years was very appealing to him.

More importantly... he did not want to risk the possibilities of future bone loss.

Bite Strength and Best Cosmetics

The treatment outcome desired by the patient included rock solid bite strength and good looking teeth that felt natural and are permanently affixed to the jaw(s). This treatment goal typically involves dental implants and porcelain-titanium bridgework.

Common denture products, while being more easily affordable, are fabricated with dental acrylic that is not stain resistant. Porcelain, in comparison, is the most stain resistant product available... even better than natural dental enamel.

Implants and Porcelain Teeth Replacements

Titanium bridgework enables patients to have a full set of new teeth with relatively few implants. More importantly, dental implants function like natural teeth in that they stimulate bone growth. The greater the number of implants.... the greater amount of bone is conserved to remain healthy.

Temporary Teeth During Implant Surgery Protocols

Successful implant surgeries require ample bone, stable bone health and the selection of appropriately sized implants along the entire arch of the bony ridge.

Temporary Immediate Denture Prosthetic
Temporary Immediate Dentures
The selection, preparation and treatments involved in each dental implant insertion site involves a few months of healing and osseointegration.

Immediate Temporary Dentures

Temporary prosthetics (denture products) are used to provide immediate new teeth while protecting underlying tissues (bone and gums).

For some patients it is possible to use temporary mini-implants to secure the denture products used to maximize bite function and eating convenience while critically important healing processes progress without interruption.

Tissue Healing: Gums and Bone

Within several weeks, the extraction sites are refortified with newly regenerated bone along with ample soft tissue (gingival-gums) regrowth. Bone augmentation replaces lost bone but does require that additional treatments designed to preserve the newly regenerated bone occur within a specific time frame.

Healed Maxillary Bony Ridge
Healthy Upper Bony Ridge Rehabilitation
The adjacent photo shows a healthy, chubby ridge of new bone and gum tissue.

CTscans and/or Panorex xrays are routinely used to confirm overall bone level and width.

Specialized planning software determines the most healthful, sensible and functional placements of dental implants that will maintain the new bone growth while providing the attachment interface for a new porcelain bridge.

Computer Based Implant Placement Accuracy

Dental implants are not a "one size fits all" type of technology. They vary in length, width and type which enables Dr. Nazarian to achieve the "best" treatment for each implant site.

Surgical Guide
Surgical Guide
The technical data generated by the planning software is used to fabricate a Surgery Guide that assures the ultimate in accuracy in placement and the type of implant used.

The adjacent photo shows a custom Guide that fits snugly onto the patient's arch and guides the implant drills into the locations specified on the ctscan treatment planning software. Correct depth and width (size of implant) is simultaneously assured.

Upper Implant Selection
Maxillary Implant Placement
Wide implants are typically used for molar positions while narrow implants are used in anterior positions.

The depth of each implant is determined by the software, which evaluates the actual height of the bony ridge.

A Surgery Guide is also developed for the lower jaw that determines best implant placements that not only take the best advantage of lower jawbone characteristics but also create the best possible foundation for replacement teeth that will correspond to the new bite physics of the new upper teeth replacements.

Lower Jaw Implants
Lower Ridge Implant Placements
This matching of biting forces typically addresses problems of bridge failure due to poorly evaluated bite physics that are created with new teeth.

In the adjacent two photos revealing implant placements, the relative "matching" of bite force locations between the upper and lower jaws is evident.

Solid support for each bridge is assured as is the promotion of the stimulative properties of implants that is important for maintaining optimal bone health.

Final Implant Osseointegration Confirmation

Final Osseointegration Testing
Ostell ISQ
Approximately 3 additional months of healing completes the osseointegration of the new implants. Temporary dentures continue to be used for maintaining basic dental function while the final healing process is completed.

Dr. Nazarian uses the Ostell ISQ, a specialized device that uses Radio Frequency Analysis for confirming final osseointegration.

Nothing is left to "guess work."

Temporary Prosthetics

Precision Implant Dentistry
Aligned Abutments
The adjacent photo shows all implants and fixed bridge abutments in place.

Temporary bridgework, crafted from reinforced acrylic materials are used to begin the final stages of designing and fabricating the final, porcelain bridgework.

Temporaries are designed to be easily modified, as needed, to obtain best bite balance dynamics, bite height, individual tooth sizing, areas that will have gingival tinting for matching the patient's gum tissues and certain smile creation properties that include smile line curvature and degree of whiteness.

Acrylic Bridgework
Temporary Bridge: Glidewell Biotemps
Temporaries are lightly cemented into place to facilitate frequent adjustments, as required.

A suitable try-in period is implemented before the final porcelain products are fabricated. ALL of the elements cited above that assure treatment goals (as specified by Dr. Nazarian) AND the cosmetic goals (defined by the patient) are addressed and achieved.

The resulting technical data is used in the final fabrication of the new titanium-porcelain bridgework.

Porcelain Bridgework
Porcelain Bridgework

Final Porcelain Bridgework

Close review of the two adjacent pictures show the modifications used to create what will appear as very natural teeth.

The tinted gingival areas were sized to the patient's "smile behavior." No matter how broadly the patient smiles, nothing will be revealed to show that the patient has bridgework.

X-ray Treatment Confirmation: Full Mouth Reconstruction

Panorex
Xray Finals
Final xrays, with bridgework in place, confirm implant placements, alignments, along with indications of optimal bone density and quality throughout.

The lower bridge is segmented, which serves to distribute biting forces along the lower jaw in a healthful fashion that eliminates overloading and maintains optimal bone health.

Questions?

Call our office at (248) 457-0500 to schedule a consultation or use our on-line Consult Request to learn more about cosmetic and functional dental makeover procedures.

Patients who have specific questions about cosmetic makeover products and bite optimization are invited to contact Dr. Nazarian directly with our Ask The Dentist form. Dr. Nazarian will respond to you directly with the answers or information you are seeking.





MI Reconstructive Implant Dentistry
Ara Nazarian, D.D.S.
1857 East Big Beaver Road
Troy MI 48083
(248) 457-0500 - Fax: (248) 457-0501
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Serving Oakland County areas of Birmingham Bloomfield Hills Clawson and Southfield