Dr. Michael Darveniza PhD, MDSc (Qld), FRACDS

PROSTHODONTIST

“Specialising in crowns, bridges & implants”

www.yourdentalspecialistlismore.com.au

Scroll down and use the arrows to view the different case studies from the beginning to the successful end of the patients treatment.

COMPOSITE RESIN OVERLAYS

This 25 year old patient while in Indonesia suffered a surfboard accident and Photo1 illustrates the fractured tooth. The patient was a close friend and I suggested he go to Singapore and find a Prosthodontist to repair the tooth. He initially decided to fly to the capital of Sumatra, Medan, and visit a Dentist who placed an ordinary bonded filling. This lasted three hours and fell out during his first meal, due to poor cavity tooth wall preparation.
The tooth was conservatively drilled by a Singapore Prosthodontist with a 2 mm wide bevel on the front and back of the tooth and then placed a larger bonded filling.
This larger bonded filling that fell out after three years of use while eating dry bread. This also fell out due to inadequate tooth preparation where the walls of the tooth could not resist a rocking motion. In dentistry this is called inadequate resistance form of the cavity and tooth walls or poor engineering. There was no incisal step and no veneer bevels.
A comprehensive cavity preparation for an overlay was prepared by Dr. Michael Darveniza in Lismore. This entailed a full frontal veneer bevel (but 0.5 mm above the gum line) with an incisal step and a retentive slot at the base of the cavity with a moderate area veneer bevel on the back of the tooth. The yellow pieces of wood are called wedges and secure the clear plastic strips to prevent the filling material getting stuck below the gum.
This shows the bonding process of the tooth along with the placement of different resin colours. The sixth photograph illustrates the final build-up of resin, before final shaping.
The final shaped resin overlay illustrating the good colour match along with some inbuilt white opaque resin to match the white fluorotic spotting of the adjacent teeth.
The patient has successfully used this overlay for five years and is very cautious on not biting extreme materials and has adhered to preventative instructions e.g. not biting fishing lines etc.

PROTECTIVE CROWNS FOR BIO-DESIGNING LEFT AND RIGHT JAW MOVEMENTS

The lower left canine is impacted and in an unprotected left jaw movement involving an extreme left movement called crossover. This crossover position shows wedging of the adjacent lower left lateral incisor between the two top teeth namely the left lateral incisor and left canine. This extreme crossover allowed the left jaw joint to dislocate quite often.
The lower right canine is unnaturally positioned and impacted against the adjacent lower right lateral incisor and being very short in stature resulting in a right unprotected cow like jaw movement. This unprotected right jaw movement allowed the contralateral left jaw joint to dislocate quite often.
A plaster model of the prepared lower canine teeth ready for fabrication of Zirconia/porcelain crowns.
The completed crowns in the mouth while the jaw was in protective right and left jaw movements. Please note the pseudo ‘microcracks’ built into the body of the crown using ceramic artistry with caramel porcelain to copy and match the adjacent microcracked natural teeth.
The colour of these teeth on these models is not indicative of what it will look like in the mouth.
The completed crowns in the mouth while the jaw was in protective right and left jaw movements. Please note the pseudo ‘microcracks’ built into the body of the crown using ceramic artistry with caramel porcelain to copy and match the adjacent microcracked natural teeth.
The patient has been using the crowns for about 2 years and no longer has dislocation and locking of the lower jaw after Full Occlusal Therapy (Paper 14-Darveniza M. Full occlusal protection – theory and practice of occlusal therapy. Australian Dental Journal 2001;46(2):70)

COMPOSITE RESIN OVERLAYS AND A CROWN

Here we have a facial view of a TMJ disorder patient before treatment with associated facial asymmetry.
And an unprotected right bite associated with poorly positioned canine teeth and a recessed 12, 13 and 14 teeth.
Here we see how the lower 43 canine is not only short in stature but rotated in towards the tongue.
The right extreme jaw movement caused by over stretching of the left TMJ jaw joint as there was no restriction present with non-engaging right canine teeth. This movement repeated over multiple times both during the day and night significantly contributed to facial asymmetry.
Line diagrams are necessary to address the dental asymmetry, upper dental midline and the bio-designing of right protective bite. This involved drilling the midline between the 11 and 21 teeth towards the left hand side and placing a filling on the mesial surface of the 11 tooth. Narrowing the distal surface of the 11 tooth to equalise the widths of the front 11 and 21 teeth. Overlaying of the 12 tooth onto the distal surface of the 11 and bringing it forward into the arch and longer was required. Similarly, overlaying the 13 and 14 was performed. The lower right 42 lateral incisor was narrowed on the distal surface to fit the lower right 43 canine temporary crown. The biting edges of the 31, 41 and 42 were adjusted to create a protective bilateral balanced forward bite with the upper front 11 and 21 teeth.
Now the bio-designed lower right 43 temporary crown creating a right protective bite.
We can clearly see that the lower jaw has moved into an extreme right jaw movement but has been stabilised and restricted by the engagement of the bio-designed lower final canine crown and upper resin overlay.
The completed aesthetic and functional occlusal bite case in hinge bite.
The completed facial appearance with significantly improved facial and dental symmetry, without the need for facial surgery.

CROWNS and BRIDGES - OCCLUSAL RECONSTRUCTION WITH 4 BRIDGES

Before treatment.
Stainless steel clips and plastic denture teeth in all four quadrants.
An anterior jig made of bees wax and multiple wafers of soft metal to determine the new facial height (nose to chin distance) required to accommodate the new crowns and bridges in hinge bite.
Temporary crowns on the canine teeth and temporary fillings on the upper lateral incisors to duplicate the facial height determined using the jig.
The completed build-up of the lower incisors with resin overlays at the desired whiter colour.
A plaster model with the prepared teeth for the right side 4 unit Zirconia bridge.
A plaster model with the prepared teeth for the left side 3 unit Zirconia bridge.
The completed 4 unit bridge from the right canine replacing 2 premolar teeth and supported by a molar tooth.
The completed 3 unit bridge from the left first premolar tooth replacing the second premolar tooth and supported by a molar tooth.
A plaster model of the prepared molar teeth for a future 4 unit bridge. The internal portion of the molar tooth illustrates a post preparation and to the side a cast metal post-core coated with an opaque porcelain.
A plaster model of the prepared teeth for a 3 unit bridge. This also illustrates the fitted post-core in the root of the molar tooth. This was required to build up vertical walls missing because the molar tooth was severely tilted. Please note the recess or well present inside the core was used to boost the retention of the bridge.
A 3 unit Zirconia bridge and a retentive Zirconia lump is evident in the molar crown and was designed to fit into the cast post-core for boosting bridge retention.
A plaster model of the prepared teeth with grooving for a Zirconia 3 unit bridge.
A. 3 unit zirconia bridge illustrating the base of the bridge or pontic tooth and inside the molar crown a zirconia rail is evident which duplicated the groove that was placed in the tooth for increased bridge retention.
The final view of the tops of the lower bridges and other teeth.
The final facial photograph of the completed reconstructed teeth without partial dentures. This Lismore patient was initially treated in Brisbane 15 years ago and I see him twice a year for a Continuous Care Appointment (CCA) and cleaning around his crowns, bridges and overlays using an airbrush that sprays a chalk/air/water air jet at the tooth and below the gumline to prevent decay and gum disease. All the crowns, bridges and overlays are intact 15 years later. He does not miss his partial dentures!

IMPLANT CROWNS, BRIDGES, DENTURES

Implant Componentry

A titanium fixture and cover screw .
An an implant fixture and healing cap, also called a healing abutment.
A fixture and a cemented abutment.
A Straumann fixture and healing abutment.
A completed zirconia implant crown (screw retained)
A rear view of the inside of a molar zirconia implant crown illustrating the metal titanium base abutment and a retentive implant screw.
The screw access hole in the implant crown and retaining screw.There is a third component called an abutment which is the connecting structure between the fixture and implant crown, which is generally a titanium base abutment which is glued to the insides of an implant crown.Occasionally, a cemented abutment is used which involves connecting the cemented type of abutment to the fixture with a small screw and cementing the implant crown to the abutment

Single implant crown front tooth and full occlusal reconstruction with crowns and composite overlays

This 50 year old gentleman suffered severe dental wear, and heavily filled and stained teeth.
He endured a fractured lower jaw from a car accident resulting in the loss of the lower left canine with a residual space and a metal splint to fixate the broken jaw as is illustrated
Subsequently, the upper left front tooth fractured and was removed and I surgically placed a Branemark implant fixture/implant crown

Single implant crown front tooth

This 60 year old lady had recurring problems with the top right crowned front tooth which was restored with a gold post crown. This post was short and angled and the post crown kept on debonding from the root and the post crown kept falling out of her mouth. Eventually decay ensued and the root cracked as illustrated in the radiograph.
The patient was referred to me in 2021 at Lismore and I referred the patient to a Periodontist in Brisbane. He extracted the tooth, placed a temporary partial denture plate to fill the space and subsequently placed a Straumann implant fixture and healing cap
I completed this case at Lismore in 2022 and this radiograph illustrates the completed the screw accessible zirconia implant crown
The completed case on the day of fitting and the gum is pale whitish in colour from the local anaesthetic.
This is the follow up in 2025

Single implant crown to replace a right front tooth

This 70 year old patient was referred to me at Lismore in 2024 by a Ballina dentist to complete an implant crown
after an Oral Surgeon placed a Straumann implant fixture and healing abutment/cap
The implant crown was secured into place and torqued
The final photograph on the day of fitting the implant crown in 2025 and colour matched with the adjacent filled left front tooth

Implant bridge - Fixed 4 unit cemented zirconia bridge following rebuilding lower jaw after cancer surgery

This 50 year old patient unfortunately developed cancer in his mouth on the lower left hand side which required complete resection or removal of the teeth, gums and lower left jawbone by a Facio-Maxillary Surgeon.
The lower jawbone was reconstructed by harvesting bone from the tibia of the leg along with a soft tissue graft consisting of calf muscle and surrounding fat tissue. Two pieces of bone were splinted in place with metal plates and screws to the remaining jawbone .
The patient was referred to me at Lismore in 2021 to replace the missing teeth with a fixed prosthesis involving an implant bridge. I designed the bridge on an OPG radiograph and issued instructions to my ceramist technician to fabricate a diagnostic wax up of the future teeth .
A surgical guiding device was fabricated with radiographic markers (vertical pink GP points) placed in the centre of the teeth to demarcate the future centroid position of the implant fixtures .
The guiding device was designed to bite optimally on the upper opposing teeth to duplicate where the future implant teeth would bite. Please note the soft tissue calf graft at this stage of treatment.
The surgical guiding device was given to the surgeon and his technical team to verify the position of my diagnostic teeth radiographic markers relative to the available bone to confirm the suitability for implant placement .
This OPG radiograph illustrates the completed 3 implant fixture and note that two of the metal splints had to be removed for implant placement. Note there was insufficient bone in the lower left canine region to place an implant which necessitated the designing of a cantilevered bridge tooth
Cemented titanium abutments were chosen to retain the future bridge .
A view of the plaster model illustrates the 4 unit zirconia bridge replacing the missing canine tooth.
Another view of the plaster model.
The completed 4 unit zirconia bridge in 2022 with metal splints repositioned .
The completed aesthetic 4 unit implant bridge.
This long journey the patient endured has resulted in a hygienic and aesthetic bridge, functional bite, improvement to his speech and support to his cheeks and tongue.

IMPLANT DENTURES

There are two basic types of implant dentures:

1. Implant dentures that are screwed into the implant fixtures making the denture not removeable by the patient but only removeable by the Dentist is called a conventional implant denture, usually All-on-4 implants.

2. Implant dentures that are removeable by the patient but fixed in while chewing etc are called Fixed-Removeable Implant Dentures and are termed by Dr. Darveniza as HYGIENIC implant dentures.

Fixed Implant denture screw retained – only removeable by dentist

A plaster model with replicas of the implant fixtures and a photo of the base of the implant denture. The base was made of titanium, pink acrylic resin and acrylic denture teeth.
A view of the back of the implant denture showing the 4 housings for the screws used to secure the denture to the implant fixtures.
After these small screws are torqued to 35 N.cm the access openings are filled with composite resin filling material. The patient needs to return every 6 months or more to have the denture removed and professionally cleaned by a Dentist.
A gap between the pink resin and the implant fixtures, these gaps are used to allow the patient to clean around the implants using threaded Superfloss and other hygienic cleaning aids.
The final facial photograph illustrating good lip support from wearing a stable fixed implant denture.

Fixed–Removeable Hygienic Implant Denture – Telescopic Denture Design - with titanium Atlantis abutments and nylon friction sleeves in a pink zirconia denture base and white zirconia teeth mounted on a titanium frame.

OPG radiograph illustrates 4 Branemark implant fixtures placed in Brisbane by Dr. Darveniza for each of the upper and lower jaws in readiness for All-on-4 Fixed-Removeable implant dentures.
The results of the software program designed by a programmer in Belgium with Dr. Darveniza to create Atlantis Abutments of the correct size and shape overlaid inside the diagnostic conventional removeable acrylic resin dentures I made.
After designing the Atlantis titanium abutments with the Belgium programmer via email, the 8 abutments were milled of titanium in Sweden.
The milled abutments with 5 degree tapered walls and a millimetre wide chamfers, and with all 4 abutments being parallel to each other in each arch.
The titanium abutments screwed into the implant fixtures on the lower arch.
The underlying surface of the implant dentures with 4 nylon frictional sleeves in each denture.
This illustrates the lower zirconia implant denture with nylon friction sleeves along side a plaster model with titanium parallel abutments for a telescopic fitting Fixed-Removeable implant denture
This illustrates the upper zirconia implant denture with nylon friction sleeves alongside a plaster model with titanium parallel abutments for a telescopic fitting Fixed-Removeable implant denture.
The implant dentures seated in the mouth biting in hinge bite.
Implant dentures biting in protective right bite initially guided by the canines and the final extreme lateral guidance path located on the 14 buccal cusp landing pad.
Implant dentures biting in protective leftt bite initially guided by the canines and the final extreme lateral guidance path located on the 24 buccal cusp landing pad.
A protective forward bite of the implant dentures.
The red marks left from red carbon paper illustrating protective hinge bite.
The black marks left from black carbon paper illustrate protective right, left and forward bites
The completed aesthetic implant dentures
Unfortunately several years later the patient had a head on motorbike/ vehicle crash and knocked out all of his upper implants and cracked his lower implant denture
The lower implant denture was replaced by Dr. Darveniza with a more robust titanium reinforced Zirconia telescopic Fixed-Removeable denture fabricated by Master Technician Werner Sauer. The metal was electrolytically coated with Rhodium for optimal hygiene.

Fixed–Removeable Hygienic Implant Denture – Telescopic Denture Design - with titanium Atlantis abutments and Syncone gold caps and acrylic resin denture base and teeth.

This 65 year old patient had numerous dental problems including decay, periodontal gum disease involving moderate to concerning future bone loss, missing teeth, heavily filled teeth and an extremely difficult very deep overbite.
An OPG radiograph illustrating a variety of dental concerns and the presence of 2 implants in the lower jaw in the first premolar regions, namely, 34 and 44.
Part of the deep overbite and a heavily discoloured top left number 2 lateral incisor previously extracted, root sectioned and amalgam filled prior to reattaching as a bonded bridge tooth to the adjacent top left number 3 canine tooth.
The remaining lower 6 front teeth that were deemed to have insufficient bone for longevity and unsuitable for a bite reconstruction, these teeth were extracted.
An OPG radiograph after the 6 extractions and Dr. Darveniza in 2014 surgically placed 2 Branemark implant fixtures between the existing 2 Ankylosis implant fixtures along with some artificial powdered RTR bone. Bone grafting adjacent to these Ankylosis implants was required following the extraction of the lower canines which had bone loss adjacent the 34 and 44 implant fixtures.
The titanium Atlantis abutments designed and milled in Sweden to be parallel to each other with a 5 degree taper.
The abutments relative to a replica gum line in a plaster model.
4 gold prefabricated Syncone caps 4 mm in height and grooved to retain pink denture acrylic resin. These caps have a frictional sliding fit onto the tapered abutments, which will retain the denture during chewing.
A plaster model with 4 abutments and 4 gold caps inside a waxed implant denture ready for processing.
The removeable implant denture in place with a normal overbite and the decay removed and fillings placed.
The red carbon paper biting marks on the teeth illustrate a protective balanced hinge bite which is responsible for keeping the lower implant denture stable when chewing.
These abutments are easy to clean following removing the denture.
The final photograph of the implant denture supporting the lower lip and an improvement to the aesthetics of the upper teeth. The patient is currently treatment planned to completely replace the stained top left number 2 lateral incisor with a white bridge and other front teeth with aesthetic Zirconia/Porcelain crowns to colour match the whiter implant denture. The patient has returned twice yearly for a Continuous Care Appointment CCA for examination, fine tune bite adjustment and airbrush cleaning with chalk, air and water around the implant gumline followed by a fluoride application. The telescopic implant denture is now on its 10th year of longevity.

TMJ = Temporomandibular Joint = Jaw Joint

The human jaw joint is a complex joint in the body as it not only hinges in hinge bite but also translates (moves out of the centre of the joint in a straight or curvilinear path) during left, right and forward bites. It relies on the TMJ disc located between the cup and head of the jaw joint which is composed of extremely hard fibrocartilage with different thicknesses. The front of the disc is about 2 mm thick and attaches to the lateral pterygoid muscle. The centre of the disc it is about 1 mm thick and this is where the head (condyle) of the jaw joint rests in hinge bite. The back of the disc is about 3 mm thick and it attaches to the posterior elastic ligament. This elastic ligament is responsible for relocating the disc back into the centre of the jaw joint following translation in left, right and forward bites. The position of the teeth is important in maintaining the head and disc in the centre of the jaw joint. If in hinge bite for example only the last molar tooth makes contact first (called a premature contact in the diagram) then this will throw out the lower jaw off centre and the position of the disc. When the disc is off centre it is called a displaced disc.

Diagram of an anterior displaced disc with reduction in the jaw, showing teeth and ligaments.

Diagram of a normal condyle, disc, and fossa assembly in a dental structure, highlighting the posterior ligament, lateral pterygoid muscle, and elastic bilaminar zone. Labels indicate premature contact in hinge occlusion at age 14. Created by Dr. Michael Darveniza.

This diagram illustrates a disc that is displaced out of the socket and the elastic ligament is very stretched because the first contacting molar tooth in hinge bite has been avoided by the lower jaw. The lower jaw has moved forward and to one side to escape this erroneously positioned tooth. The result as displayed in this diagram shows all the teeth meshing to be able to now eat. However, the head is no longer positioned in the centre of the jaw joint and the disc is displaced. The patient now has a clicking disc and the beginning of a TMJ Disorder which is abbreviated TMD.

Full Occlusal Therapy for a Temporomandibular Disorder (TMD)

A TMJ Disorder patient requires conservative management with “Full Occlusal Therapy” in 3 stages along with concurrent Full Counselling (refer to journal papers 19 and 20). In other words, we need to get the disc back into the centre of the joint where it belongs starting with Full Counselling and then a Fully Protective Occlusal Splint (Stage 1). This splint is made of acrylic resin (used for dentures) and can be made in clear resin but is usually coloured blue or pink to hide any future discolouration (as in the photos below). The splint usually fits the upper teeth and only one is required.

INTRODUCTION TO OCCLUSAL SPLINTS

COLOURED ACRYLIC RESIN SPLINTS FOR UPPER TEETH BEFORE FITTING- 2 different patient cases
MEDIUM THICKNESS LIGHT PINK UPPER SPLINT 13 YEAR OLD GIRL TMJ DISORDER

Fully Protective Occlusal Splint Therapy - Stage 1 of Full Occlusal Therapy

RED MARKINGS INDICATING BALANCED HINGE BITE AND LONG GUIDING AND CENTRING PATHS FOR FORWARD, RIGHTAND LEFT EXTREME JAW MOVEMENTS
This patient has a serious grinding or bruxing habit that was intercepted before he destroyed all his teeth. This photo shows a left unprotected bite with cow like jaw movement which not only allowed the wear to accelerate but also damaged his TMJ jaw joints with pain.
PROTECTIVE HINGE BITE AND THICK SPLINT TO RELAX GRINDING MUSCLES
PROTECTIVE FORWARD BITE
PROTECTIVE RIGHT BITE
PROTECTIVE LEFT BITE

Occlusal equilibration = Occlusal adjustment = Bite adjustment - Stage 2 of Full Occlusal Therapy

Full mouth reconstruction in 1990 with crowns in protective hinge bite with bilateral tooth contacts
Full mouth occlusal reconstruction in 1990 with crowns illustrating right protective bite
Before - premature contacts on the upper back teeth on the left side of the face and the red marks show incline to incline contacts which are inappropriate for a protective occlusion or bite. An incline to incline bite is equivalent to scissors contacting and is very destructive to the teeth often ending in tooth cracking and either loss of a tooth or root canal treatment or a crown.
After - As a matter of interest, patients with incline to incline contacts often make grating or scratching high pitched noises when they bite. Here we see a completed stable protective hinge bite illustrating the red marks that are equal in area, balanced and have the ideal bite which is called colloquially cusp tip to flat (helicopter landing pads).

Anterior Guidance or Molar Guidance for Stage 3 of Full Occlusal Therapy

After occlusal equilibration the final stage of Full Occlusal Therapy is to protect the bite, muscles and TMJs by bio-designing anterior or molar lower jaw guidance. This involves key teeth, usually canine or very infrequently molars for lateral guidance of right and left bites or central incisor teeth for protrusive or forward bite. This is performed by increasing the size and shape of these teeth with resin overlays or crowns, where necessary, to guide and restrict cow-like horizonto lateral lower jaw movements or unprotective unilateral protrusive forward jaw movements to prevent future TMJ and muscle damage and symptoms. For more details refer to the case study on CROWNS titled “Protective crowns for bio-designing left and right jaw movements” and journal papers 14 and 21.

PROSTHODONTIST

“Specialising in crowns, bridges & implants”

The tooth was conservatively drilled by a Singapore Prosthodontist with a 2 mm wide bevel on the front and back of the tooth and then placed a larger bonded filling.

This shows the bonding process of the tooth along with the placement of different resin colours. The sixth photograph illustrates the final build-up of resin, before final shaping.

The final shaped resin overlay illustrating the good colour match along with some inbuilt white opaque resin to match the white fluorotic spotting of the adjacent teeth.

The patient has successfully used this overlay for five years and is very cautious on not biting extreme materials and has adhered to preventative instructions e.g. not biting fishing lines etc.

A plaster model of the prepared lower canine teeth ready for fabrication of Zirconia/porcelain crowns.

The completed crowns in the mouth while the jaw was in protective right and left jaw movements. Please note the pseudo ‘microcracks’ built into the body of the crown using ceramic artistry with caramel porcelain to copy and match the adjacent microcracked natural teeth.

The colour of these teeth on these models is not indicative of what it will look like in the mouth.

The completed crowns in the mouth while the jaw was in protective right and left jaw movements. Please note the pseudo ‘microcracks’ built into the body of the crown using ceramic artistry with caramel porcelain to copy and match the adjacent microcracked natural teeth.

The patient has been using the crowns for about 2 years and no longer has dislocation and locking of the lower jaw after Full Occlusal Therapy (Paper 14-Darveniza M. Full occlusal protection – theory and practice of occlusal therapy. Australian Dental Journal 2001;46(2):70)

Here we have a facial view of a TMJ disorder patient before treatment with associated facial asymmetry.

And an unprotected right bite associated with poorly positioned canine teeth and a recessed 12, 13 and 14 teeth.

Here we see how the lower 43 canine is not only short in stature but rotated in towards the tongue.

The right extreme jaw movement caused by over stretching of the left TMJ jaw joint as there was no restriction present with non-engaging right canine teeth. This movement repeated over multiple times both during the day and night significantly contributed to facial asymmetry.

Now the bio-designed lower right 43 temporary crown creating a right protective bite.

We can clearly see that the lower jaw has moved into an extreme right jaw movement but has been stabilised and restricted by the engagement of the bio-designed lower final canine crown and upper resin overlay.

The completed aesthetic and functional occlusal bite case in hinge bite.

The completed facial appearance with significantly improved facial and dental symmetry, without the need for facial surgery.

Before treatment.

Stainless steel clips and plastic denture teeth in all four quadrants.

An anterior jig made of bees wax and multiple wafers of soft metal to determine the new facial height (nose to chin distance) required to accommodate the new crowns and bridges in hinge bite.

Temporary crowns on the canine teeth and temporary fillings on the upper lateral incisors to duplicate the facial height determined using the jig.

The completed build-up of the lower incisors with resin overlays at the desired whiter colour.

A plaster model with the prepared teeth for the right side 4 unit Zirconia bridge.

A plaster model with the prepared teeth for the left side 3 unit Zirconia bridge.

The completed 4 unit bridge from the right canine replacing 2 premolar teeth and supported by a molar tooth.

The completed 3 unit bridge from the left first premolar tooth replacing the second premolar tooth and supported by a molar tooth.

A plaster model of the prepared molar teeth for a future 4 unit bridge. The internal portion of the molar tooth illustrates a post preparation and to the side a cast metal post-core coated with an opaque porcelain.

A 3 unit Zirconia bridge and a retentive Zirconia lump is evident in the molar crown and was designed to fit into the cast post-core for boosting bridge retention.

A plaster model of the prepared teeth with grooving for a Zirconia 3 unit bridge.

A. 3 unit zirconia bridge illustrating the base of the bridge or pontic tooth and inside the molar crown a zirconia rail is evident which duplicated the groove that was placed in the tooth for increased bridge retention.

The final view of the tops of the lower bridges and other teeth.

A titanium fixture and cover screw .

An an implant fixture and healing cap, also called a healing abutment.

A fixture and a cemented abutment.

A Straumann fixture and healing abutment.

A completed zirconia implant crown (screw retained)

A rear view of the inside of a molar zirconia implant crown illustrating the metal titanium base abutment and a retentive implant screw.

This 50 year old gentleman suffered severe dental wear, and heavily filled and stained teeth.

He endured a fractured lower jaw from a car accident resulting in the loss of the lower left canine with a residual space and a metal splint to fixate the broken jaw as is illustrated

Subsequently, the upper left front tooth fractured and was removed and I surgically placed a Branemark implant fixture/implant crown

The patient was referred to me in 2021 at Lismore and I referred the patient to a Periodontist in Brisbane. He extracted the tooth, placed a temporary partial denture plate to fill the space and subsequently placed a Straumann implant fixture and healing cap

I completed this case at Lismore in 2022 and this radiograph illustrates the completed the screw accessible zirconia implant crown

The completed case on the day of fitting and the gum is pale whitish in colour from the local anaesthetic.

This is the follow up in 2025

This 70 year old patient was referred to me at Lismore in 2024 by a Ballina dentist to complete an implant crown

after an Oral Surgeon placed a Straumann implant fixture and healing abutment/cap

The implant crown was secured into place and torqued

The final photograph on the day of fitting the implant crown in 2025 and colour matched with the adjacent filled left front tooth

This 50 year old patient unfortunately developed cancer in his mouth on the lower left hand side which required complete resection or removal of the teeth, gums and lower left jawbone by a Facio-Maxillary Surgeon.

The lower jawbone was reconstructed by harvesting bone from the tibia of the leg along with a soft tissue graft consisting of calf muscle and surrounding fat tissue. Two pieces of bone were splinted in place with metal plates and screws to the remaining jawbone .

The patient was referred to me at Lismore in 2021 to replace the missing teeth with a fixed prosthesis involving an implant bridge. I designed the bridge on an OPG radiograph and issued instructions to my ceramist technician to fabricate a diagnostic wax up of the future teeth .

A surgical guiding device was fabricated with radiographic markers (vertical pink GP points) placed in the centre of the teeth to demarcate the future centroid position of the implant fixtures .

The guiding device was designed to bite optimally on the upper opposing teeth to duplicate where the future implant teeth would bite. Please note the soft tissue calf graft at this stage of treatment.

The surgical guiding device was given to the surgeon and his technical team to verify the position of my diagnostic teeth radiographic markers relative to the available bone to confirm the suitability for implant placement .

This OPG radiograph illustrates the completed 3 implant fixture and note that two of the metal splints had to be removed for implant placement. Note there was insufficient bone in the lower left canine region to place an implant which necessitated the designing of a cantilevered bridge tooth

Cemented titanium abutments were chosen to retain the future bridge .

A view of the plaster model illustrates the 4 unit zirconia bridge replacing the missing canine tooth.

Another view of the plaster model.

The completed 4 unit zirconia bridge in 2022 with metal splints repositioned .

The completed aesthetic 4 unit implant bridge.

This long journey the patient endured has resulted in a hygienic and aesthetic bridge, functional bite, improvement to his speech and support to his cheeks and tongue.

IMPLANT DENTURES

A plaster model with replicas of the implant fixtures and a photo of the base of the implant denture. The base was made of titanium, pink acrylic resin and acrylic denture teeth.

A view of the back of the implant denture showing the 4 housings for the screws used to secure the denture to the implant fixtures.

After these small screws are torqued to 35 N.cm the access openings are filled with composite resin filling material. The patient needs to return every 6 months or more to have the denture removed and professionally cleaned by a Dentist.

A gap between the pink resin and the implant fixtures, these gaps are used to allow the patient to clean around the implants using threaded Superfloss and other hygienic cleaning aids.

The final facial photograph illustrating good lip support from wearing a stable fixed implant denture.

OPG radiograph illustrates 4 Branemark implant fixtures placed in Brisbane by Dr. Darveniza for each of the upper and lower jaws in readiness for All-on-4 Fixed-Removeable implant dentures.

The results of the software program designed by a programmer in Belgium with Dr. Darveniza to create Atlantis Abutments of the correct size and shape overlaid inside the diagnostic conventional removeable acrylic resin dentures I made.

After designing the Atlantis titanium abutments with the Belgium programmer via email, the 8 abutments were milled of titanium in Sweden.

The milled abutments with 5 degree tapered walls and a millimetre wide chamfers, and with all 4 abutments being parallel to each other in each arch.

The titanium abutments screwed into the implant fixtures on the lower arch.

The underlying surface of the implant dentures with 4 nylon frictional sleeves in each denture.

This illustrates the lower zirconia implant denture with nylon friction sleeves along side a plaster model with titanium parallel abutments for a telescopic fitting Fixed-Removeable implant denture

This illustrates the upper zirconia implant denture with nylon friction sleeves alongside a plaster model with titanium parallel abutments for a telescopic fitting Fixed-Removeable implant denture.

The implant dentures seated in the mouth biting in hinge bite.

Implant dentures biting in protective right bite initially guided by the canines and the final extreme lateral guidance path located on the 14 buccal cusp landing pad.

Implant dentures biting in protective leftt bite initially guided by the canines and the final extreme lateral guidance path located on the 24 buccal cusp landing pad.