Several years ago, a patient had three upper front teeth removed due to an old childhood injury. Unfortunately, the oral surgeon removed too much bone on the front of the ridge, and her upper lip lacked support, resulting in a “caved in” look in photographs. Four different surgeries by four different specialists all failed to restore the bulk of the ridge, and when the implants were finally placed, they needed to be positioned too far toward the roof of the mouth for ideal esthetic restoration.
A search of dental literature made no mention of ways to remedy this deficiency, and we were forced to be inventive. And so, in close consultation with our dental laboratory, we elected to restore the area with a restoration that was part dental bridge, and part partial denture. In essence, it would use porcelain to replace the teeth, but also would use gum-colored composites to replace the missing bone and gum tissues, and hence to give support to the lip.
Because of its innovative nature, we wanted to be able to remove the bridge at regular intervals in order to monitor the health of the covered gum tissue; no one had any idea how the tissue would respond, as the close adaptation of the porcelain to it over a long period of time was essentially unknown.
Six years now, from the initial placement, we are happy to report, the tissue looks and feels very healthy. We were able to get a very esthetic, very functional result, with excellent esthetics. Because we also restored the other teeth in the upper arch with the same materials and the same time (although as individual crowns), we were able to achieve a symmetry in form, and and absolute match in color, in all lighting conditions. And the gum-colored porcelain gave support to her upper lip that completely restored the sunken area, and at the same time prevented air leakage beneath the bridge. The patient was very very happy with the results.
Just an example of the innovative ways in which we apply our knowledge in restorative materials, fixed and removable dentures, crown and bridge, and implant dentistry for the benefit of our patients.