All on 4/6 Prettau Fixed Implant Bridge Lip and Facial Support Considerations

If you lose all of your teeth, your jawbone and eventually your face will shrink. This cannot be stopped even with bone grafts. It naturally happens because of atrophy (lack of use) of both muscle and bone of the jaws. I have discussed this bone loss in many previous blog and web articles.

If you’re having an all on 4/6/8 etc dental implant Prettau style bridge, this is an important consideration for facial aesthetics. Being able to support your face means that the lips, the base of the nose and cheeks can be positioned correctly so that you don’t have a caved in, wrinkled appearance.

Many dentists believe this cannot be done with fixed dental implant bridges and offer their patients snap-on overdentures. I have found there to be a lack of uniform knowledge of regular general dentists on this topic mostly because most dentists do not do this procedure routinely.

This issue is more substantial when discussing the upper jaw. A lack of facial/lip support also makes the nose appear much larger than it really is.

In the past (prior to 2005), I too treated some patients with upper overdentures to try to make facial esthetics the best possible but you still end up with a plastic denture! As of about 12 years ago I have developed a technique for predictably re-creating lip support and face aesthetics eliminating the need for upper overdentures. Lip and facial support are also determined by what we call vertical dimension of occlusion “VDO.”

This is best seen in side profile but can also be seen straight on. It is often measured from the tip of the nose to the tip of the chin. If you lose all of your teeth, that measurement from the tip of the nose to the tip of the chin becomes smaller giving you a premature aged appearance and many wrinkles.



Where many dentists believe this can’t be done is in the cleansability of the final Prettau dental implant restoration. I have been advocating and teaching a technique that levels the bone and gum to create a flat or convex surface UNDER the bridge so that the bridge can both be cleansable and aesthetic at the same time.

The fact that Prettau monolithic zirconia is nonporous also helps tremendously. It is not material of the bridge that makes the lip support but rather the surgical and prosthetic planning of the case from the very beginning.

Every single patient I treat has a very particular surgical modification of the gum or bone anatomy to be able to *create* this scenario right from day one. This is done by me at the first surgery. If it is not considered and created from the very first surgery/insertion of implants, it is very difficult to recover and correct later.

I also feel it is very important to “test” every patient with a fixed temporary PMMA bridge that allows them to test facial aesthetics, bite, lip support, color, tooth shape and size, etc. etc. I usually allow the patient to test the prototype bridges for somewhere between 3 weeks to 3 months. They look great too!

I often touchup this gum created contour with a carbon dioxide laser at the beginning of the tooth making process.

I also see that over time once I create a solid biting plane of occlusion, the atrophied, flabby muscles begin to come back over the first year or 2 tightening up the face.

There are some exceptions to creating ideal lip support and it almost always occurs in a patient that has either a severe overbite or severe underbite. When this occurs, sometimes a slight concavity needs to be created in a very certain position that can be digitally designed to be VERY cleansable with a water pick. This will lead to long term crestal bone and gum stability.

This patient that photographed has 6 implants on top and 5 implants on bottom and upper lower fixed Prettau bridges. It is my passion to deliver teeth that are long-lasting, cleansable, well engineered and beautiful. It really changes lives.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry


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6 thoughts on “All on 4/6 Prettau Fixed Implant Bridge Lip and Facial Support Considerations

  1. Laura Martinez

    Dr. Amin.. DO U KNOW HOW BLESSED I’D BE TO SMILE OR FEEL SECURE BOUT MYSELF.. I HAVEN’T SEEN A DENTIST SINCE I WAS 15YRS OLD..DR AMIN.. AT 8 YRS OLD MY WHOLE LIFE CHANGE, MY BIOLOGICAL FATHER TOOK MY INNOCENCE ALL MY TEEN YRS ONLY BCUZ HE HAD GOTTEN EXPOSED FOR THE ABUSE.. NOW NOT ONLY WAS SEXUALLY ABUSE, BUT PHYSICALLY, VERBALLY AN EMOTIONALLY BY THIS MAN FOR 12 YRS.. U COULDN’T IMAGINE, NOW FROM ALL THE PUNCHES IN MY MOUTH AND BEING CHASED DOWN THE DIRT ROAD AT NIGHT AND RUN DWN BY MY DAD.. HE DROVE FORWARD AN REVERSED.. ASK ME WHY IM NOT DEAD.. WELL I KEEP ASKING MYSELF THAT FOR YRS.. A FEW YRS AFTER I MET A MAN THAT ABUSED ME FOR 6 YRS.. THE FATHER OF MY 2 OLDEST AND THRU THE YRS I JUST NEVER HAD THE FUNDS TO SEE A MEDICAL OR DENTAL TO CARE FOR MY NEEDS.. I JUST HID MY PAINS AN TEETH ALL THESE YRS.. NOT MY TEETH ON TOP FRONT ARE SO LOOSE AN EXTRACTED.. I GOT NO BACK TEETH ON TOP.. AN MY LOWER TEETH ON FRONT JUST SHIFTED AND GOT CROOKED.. AN WEN I DID SEE THAT DENIST AT 15 THEY WERE CAVITIES FILLED.. THAT R NOW DECAYED.. UP TO 10 YRS AGO I BCAME A SMOKER FROM THE STRESS, DEPRESSED, ETC.. BUT INOW TELL MY GROWN KIDS THAT IF I’D FIX MY TEETH AN I COULD SMILE AN BE HAPPY.. I WOULD CHANGE ALOT IN MY LIFE AN PROMISES I MADE TO GOD.. IVE APPLIED IN GRANTS AN LOW INCOME HELP.. BCUZ I COULDN’T AFFORD DENTAL IMPLANTS .. AND WERE I LIVE IN CORPUS CHRISTI TX, THEY DON’T GOT PROGRAMS.. SO YES MR. AMIN IF U CAN HELP.. I’D APPRECIATE IT.. IM 48 YRS OLD .. I WANT MY LIFE BAK.. THK U

    Reply
    1. RamseyAminDDS Post author

      Wow thank you for being so vulnerable and sharing your story. The best advice I could give you would be in the short term to have a very nice set of full dentures made. You can have a pretty smile with some “custom” dentures rather than just standard dentures.

      This will allow you to get your life back on track and give you more self-confidence and perhaps later on consider having dental implants. Keep in mind that dental implants require maintenance so you don’t want to end up having a procedure that you cannot afford to maintain over time.

      For example, let’s say something goes wrong with your implants and you require multiple surgical correction years down the road. That may put you in a bad situation of being untreatable again due to finances. You may want to seek treatment in a dental school also. Their fees are not that much less though. ;(

      I hope you can find the strength and inner peace to move on from all of this.

      Very Respectfully… Dr. Amin

      Reply
  2. Andrea L. Stacy

    I live in L.I., N.Y. I just turned 65 and after having tens of thousands of dental work done I am now being told I will probably lose all my teeth. I am more than hysterical-after my fifth bridge in upper front teeth(stemming from being in accident-a passenger at age 14 and lost a front tooth-probably swallowed) At any rate I received a whopping $2,000 because my lawyer said I was much too pretty to receive any sympathy! Unfortunately my fiancé died leaving me without funds-I became an RN and re-couped my losses-I had to go on disability due to a severe back injury;then went off a ladder at my daughter’s home and was life-flighted to repair the compound fractures with ORIF-I’ve been paying off those bills and face more surgery. A dentist said I was getting decay under last front bridge-pulled out all my upper teeth and placed bonded together temps. I could waste your time with more traumas but since I cannot get to you I’m praying for anyone nearly as competent as you to be found closer to home.Please excuse this poorly written tale-I am in excruciating pain as I write. I cannot bear dentures. (small bite) I briefly had a temp plate which was intolerable. I have a small home I will sell not to have dentures. Please help if possible. I’m still pretty but it’s not simply vanity-it’s the intolerance of all the effects of dentures. Thank You.

    Reply
    1. RamseyAminDDS Post author

      So sorry about what you are dealing with 🙁

      Fortunately you live in NY which is full of great dental opportunity. Just do your due diligence and find a provider who is skilled, experienced and compassionate.
      Since your case is complex make sure you understand what you are getting into.

      Reply