Select Page
Bone augmentation for two incisors

Bone augmentation for two incisors

00286304 PICT0046 PICT0003  PICT0006 PICT0020 0028631S 0028631W 00286323 0028632K
this is a quite complicated case, as for the degree of bone destruction, the esthetic demand, and the surgical-prosthetic procedures involved in the process. View full processe here…

Initial phase: extractions and healing
Old metal-ceramic crown work over devitalized incisors. Periodontal abscess, retracted alveolar front wall, frontal gingival recession, central incisor presenting endo-periodontal injury around root apex.
00286305002863060028630700286304  PICT0045PICT0046
Extractions are done and an immediate removable prosthesis is placed during the healing period. Acrylic relines are successively done to keep contact between the resin and the gum, in order to prevent further resorption.
One thing should be taken into consideration: a different approach could be done by filling the sockets with bone graft and covering them with a membrane.  With the existing endo-perio pathology it may be a safer play to let it heal by itself. Second, there is short soft tissue over the central incisor as to cover the resorbable membrane.
0028630800286309 PICT0002PICT0003
Surgical phase: implant placement, bone augmentation
The two implants are placed along the convenient axis, already expecting exposure of a few threads. The Bio-Guide membrane is cut to fit in the edentulous gap, holes are poked to screw the implants’ healing screws throw it, acting as fixation.
 PICT0006 0028631GPICT0007PICT0008PICT0010PICT0011PICT0012PICT0013
Enough membrane margin  is left to fit under the palatal flap and several holes are poked on the apical end of the membrane.  First, to drill through the pin retention. Second, to nail the pins through.
Once the pin holes are drilled with no tension on the membrane (it should be baggy enough as to allow for sufficient graft volume), a little blood is extracted, mixed with Algipore, and placed over the implant’s threads and the bone concavity.
The resorbable pins are nailed carefully fitting them through the membrane holes and into the previously drilled socket retentions.
PICT0025PICT0026PICT0027 PICT0028 PICT0029PICT0031PICT0033 PICT0039
Periosteal cuts are done under the full thickness flap. This permits further elongation of the flap in order to close the wound over the increased volume base.
PICT0040PICT0042PICT0043PICT0044 PICT0047PICT0050
Implant osseointegration phase: 6 months
The acrylic removable prosthesis is immediately relined to fit over the suture and checked up periodically for later relines in order to keep contact with the gum.
Prosthetic phase: Procera veneers and metal-ceramic crowns over angled pillars
0028631O0028631Q0028631P 0028631S
00286324 002863220028631U0028631T0028631W0028631V00286323
During the try-on, the left central incisor doesn’t fit precisely. Maybe due the tooth migration, maybe due to impression accuracy. So the cuspid’s veneer is cemented and second impressions are taken for the final result, incorporating pink ceramic to disguise the implants’ high emergence.
  00286325 00286326 00286327 00286328 0028632K00286329  0028632A

Combined case. Restorations, Orthodontics, Implants & Veneers. Five & ten year results.

 0018092J0018090H001809180018090W 0018091D 0018091J0018092000180925IMGP1011
This a long, multidisciplinary case, involving peridontics, endodontics, resin restorations, orthodontics, implants and venners.You can view the full process here…

 0018090J 0018090A 0018090B
 IMGP1011  IMGP1014 IMGP1017
Restorative phase
0018090E 0018090F 0018090G
0018090C 0018090D 0018092J 0018090H  0018090I00180918 0018090L 0018090M
0018090P 0018090O 0018090N
IMGP1012 IMGP1011 IMGP1013
0018090S 0018090R0018090Q
0018090W 0018090V 0018090U
0018090Z 0018090Y 0018090X
Orthodontics & Implants on 12, 35
00180913 00180914 00180916 00180917
 0018091D0018091C 0018091E
0018091H 0018091I
Removal of orthodontics, bleaching & retainer
Prosthetic Phase & retainer
0018091O 0018091N 0018091P
0018091Y 0018091W  0018091X
00180920 00180921 0018092800180927 0018092400180923 00180922 0018092C 00180926 00180925 00180929
results: 5yrs post implantary phase, 10yrs from restoration
alexis sanchez
 IMGP1012 IMGP1011 IMGP1013 IMGP1014 IMGP1017
  IMGP1021 a IMGP1022 a
IMGP1025 a IMGP1020 a IMGP1023 a
Veneers on tainted teeth with periodontal disease

Veneers on tainted teeth with periodontal disease

This case shows the procedure to make a smile make over with a combination of periodontal treatment and prosthetics.

00228300 0022830R

The patient arrives with moderate periodontal disease, lack of hygiene, severe stains due to excessive Fluor in the water he drank during childhood,  and, of course, smoking.

Exploration with probe shows bleeding and periodontal pockets over 3-4mm. So, first, we clean the gums thoroughly and watch the evolution of new hygienic habits for several weeks. Teeth should be rather taller than wider, in a proportion of 2(width) to 3 (height). This case is the other way around.


Then, I do a gingivoplasty. This is the surgical removal of gum tissue (gingiva), reshaping around teeth to a more proportional, healthy and esthetic shape.


Now we have a healthier, more esthetic look, 2 by 3 in proportion, that even shows the effect of smoke. The light band of previously covered neck section of the teeth vs… the smoked front section.

00228302 00228309

Stains cannot be removed by bleaching or whitening, since they are too dark and deep in the enamel. Plus, there are open spaces. So I proceed to carve to teeth with a controlled depth of 0.5mm on the front side, up to the gums.

0022830A 0022830C

Then, I remove the incisal edge of the teeth to let space for the veneers that will fit on top. Otherwise they would be so thick that the bite would only touch on the veneers, breaking them.

0022830B 0022830F

A set of two thin threads are placed in the gun pocket. This phase would have been impossible to carry out without the convenient periodontal treatment explained before.

The ultimate purpose is to get a healthy gum tissue that doesn’t bleed when a silicon impression is taken. Bleeding gums provoke bubble distortions in the silicone impression, and an inaccurate cast.

0022830G 0022830J

A precision cast is made out of the silicone impression. The cast is scanned by a in-office CAD-CAM system called Procera. The scanned data are sent to the Procera headquarters in Sweden, where they make the inner part of the veneers.

0022830K 0022830I

Temporary acrylic veneers are bonded while waiting for laboratory working times. Several layers of ceramic colors are placed over the Procera nucleus to reach the final translucent color.  After we test a perfect adaptation and convenient color match, we bond the ceramic veneers.

0022830Q 0022830S

In this case we only substituted the four front teeth. If the veneers had been more as to cover 6,8 or 10 teeth, the color could have been completely changed into a new one. But in this case we tried to camouflage the veneers with color and little white stains of the nearby teeth.

0022830O 0022830P

Are they strong? Do they come off?

Well, here is a good example.

Three years after, the patient hit himself with the edge of the pool, and here is what happened.

0022830W 0022830U

Only a slight ding on the color ceramic covering . No cracks in the under structure. So I repaired it easily with a combination of composite resin colors, to match the ceramic.


You can chew on these veneers as much as you can. They will not come off. The bonding used is the same as for regular fillings, but the bonding force is huge thanks to the large area of bonding, compared to the reduce leverage.

Risk of fracture is minimized by controlling the depth of the carving, and allowing enough thickness to the nucleus and cover not to break upon load.