Uptown Comprehensive Dentistry and Prosthodontics: John Chen, DDS

At first glance I thought this patient's teeth were "nice." They were white and they were straight. But after a lengthy conversation I realized this wasn't what she wanted. The teeth were too white, too big, too straight with no character. She felt like she's got a mouthful of teeth. Our patient wanted something more natural. We dialed down the brightness, softened the teeth, opened up the embrasures and the buccal corridor.

Another set of teeth delivered. A bit more technical than most with nine implants on the upper and seven on the lower. All direct to platform and different systems.

I rarely post dentures, but this one I thought is worth sharing. Patient had every possible problem with her denture imaginable. They were ill fitting, teeth did not match up, she couldn't close her mouth, she couldn't speak... We were able to address all of her issues and give her the result she wanted.

A different kendo of dental meet up: last weekend Dr. Chen from Uptown Prosthodontics teamed up with Hiossen Dental Implants and Quest Dental to compete in the Rensei Taikai hosted by SWKIF in Tulsa, OK. Overall it was a great experience and a nice change in setting to discuss dentistry and swordsmanship.

What does a prosthodontist and the Hiossen rep do outside of work? We cross swords. ⚔️

These worn and stained composite restorations are refreshed with a set of new porcelain veneers.

This case started out as a fairly straightforward rehab, until the patient changed her mind on the shade after I've made my definitive impressions. We jumped from B1 to OM1. I always try to be as conservative as possible so I prepared for 360° porcelain veneers with only ~0.5mm of reduction. To address this problem I either had to reprep every tooth, remake and remount the case, or in this case I changed the restorative material to monolithic zirconia to block out the stump shade.

I'm old school and prefer analog... I've made almost every implant provisionals myself by hand. This was no doubt the largest provisional restoration I've made to date.

Work in progress. 3 month implant provisional followup. This case is difficult for many reasons. High smile line, wide smile, excess gingival display, and worst of all, the anterior implants were already placed prior to consultation. A traditional all-on-X restoration is not possible. I am forced to tissue mold the entire arch. It is very important to discuss possible tx outcomes and set realistic expectations.

Exaggerated smile. Too often I remove an existing fixed hybrid to find a rough concaved surface with food accumulation and infection around implants. This isn't due to the patient's lack of oral hygiene, but poor treatment planning by the restoring dentist. Inadequate bone reduction and shallow implant placement makes a fixed implant restoration difficult unless a fl**ge is added to hide the gum-pink interface. This is why lip mobility and gingival display at exaggerated smile is so important during the initial consult.

Art meet science.

Detail matters. Patient came in with an overhanging #7 implant crown cemented on a stock abutment. The crown was as wide as her central. Simply by tissue molding and some composite, we were able to correct the subgingival contour and improve symmetry.

There are a lot to consider for a substitution case to be successful: pre and post-op morphology, gingival contours, line angles, prep design... This patient is missing a central incisor and going through tough orthodontic treatment. We decided to triple substitute instead of opening up space for an implant. We turned a lateral into a central, a canine into a lateral and a premolar into a canine.

Case progression. Patient presented 7 years ago, with an acrylic titanium hybrid with a non passive framework, inadequate restorative space, constant acrylic breakage, uneven occlusion and aesthetic issues. Her case was redone... Fast forward to 2023, and we copied her restorations into monolithic zirconia.

Upgrading acrylic titanium to zirconia. Notice the last molar was copy milled into titanium framework due to the lack of restorative space planned. With newer monolithic material, zirconia requires less space.

All-on-4 + 2 x Zygoma Implants before and after. My last case with Dr. Bryce Williams before he passed away. I miss you bro. ☝️🙏

Surgical colleague:

The aesthetic zone is defined by the patient.

I start every reconstruction with placing the maxillary centrals followed by vertical dimension. This patient liked the wax setup and the provisional day of delivery, but two days later she called me saying,

"They are too long. I don't usually show teeth when I talk. I don't like to show teeth when I smile. My canines were pointier."

The PMMA provisional was adjusted to reflect her wishes. This shows the importance of the PMMA provisional restoration as a tool to evaluate aesthetics and function.

Not bad for an 80 year old smile. Previous case at delivery.

Surgical colleague:

All-on-5 vs. all-on-4 monolithic zirconia with pink porcelain ready for delivery.

What ideal daily maintenance looks like and why dialing in the tissue side contour is so important. Our patient moved away after we re-did her acrylic titanium hybrids in 2016. Note the titanium molar that had to be copy-milled as part of the titanium bar due to lack of space. The tissue side of the bar was also done in titanium and polished to minimize plaque trap. The patient didn't want anyone else to work on her so These restorations HAVE NOT BEEN REMOVED since our patient moved. To my surprise, this was what the tissue looked like immediately after I removed her restorations. Not even a swish of water. Not a bit of plaque. Tissue coral pink. Absolutely immaculate after 7 years in the mouth.

The three musketeers. All for one, one for all.

Previous All-on-X case: PMMA trial provisional delivery.

Surgical by: Aurora Periodontics & Implants

"Another one" All-on-X case: wax setup -> PMMA trial provisional.

A case with severely worn dentition and collapsed occlusion. The decision was made to remove and replace anterior teeth with implant restorations. VDO re-established at +5mm. Monolithic zirconia crowns were delivered, sacrificing aesthetics for strength.

Surgical colleague:

Previous All-on-X case: PMMA trial provisional delivery.

Surgical by:

All-on-X case: wax setup -> PMMA trial provisional. Tissue contour, aesthetics and occlusion are dialed in through multiple try-ins prior to fabrication.

Surgical by:

We are extremely excited to announce the addition of Dr. Jennifer Still to our team!

A Southern California native, Dr. Jennifer Still attended the University of Southern California for both undergraduate studies as well as Dental School. Upon graduation, Dr. Still and her husband moved to San Diego and called it their home for most of the last 14 years before settling in Colorado. Dr. Still is honored to work with Dr. Chen (her dental school classmate) in providing top notch dental care in a comfortable family atmosphere. Dr. Still knows that dental success comes from ongoing education and keeping up to date with the latest technological advancements. She enjoys the artistic and clinical aspects of her career and she is committed to making each patient's experience both comfortable and enjoyable. With an undergraduate background in public health, Dr. Still also has extensive knowledge in the oral-systemic connection and looks forward to educating patients on how their dental health affects their overall health. In her spare time, Dr. Still enjoys cooking, running, and spending time outdoors with her husband and three children.

It's been crazy being a father of 2... But we're back!

This case took a couple of years to complete involving orthodontic therapy, orthognathic surgery, implant surgery and full mouth implant/tooth borne restorations.

Before & after: #7, #10 lateral implant restorations.

When a patient asks how long should veneers/crowns last, I always have difficulty answering them. 10 years? 20 years? 30 years? I don't think I've practiced long enough to see my failures.