A patient presented following a fall resulting in severe trauma to the four maxillary incisors. Clinical examination showed extensive structural damage affecting the upper central and lateral incisors, with the teeth considered unrestorable. The case required management of both the immediate consequences of trauma and the long-term restorative challenge in the anterior maxilla.

Clinical Assessment

The patient’s main concerns were pain, appearance, and the loss of function in the upper anterior region. Clinical assessment identified significant fracture and compromise of the four upper incisors. In addition to the dental injury, attention was given to the condition of the surrounding soft tissues and the aesthetic implications of treatment in the smile zone.

Pre-operative clinical views demonstrated the extent of the trauma and the compromised condition of the maxillary incisors . Radiographic assessment was carried out to evaluate the remaining bone support and to guide implant planning. The aim was to provide a fixed restoration with good functional and aesthetic predictability while minimising surgical intervention.

Treatment Planning

As the four maxillary incisors were unrestorable, extraction was indicated. The restorative plan was to replace the missing teeth with a four-unit implant-supported bridge retained on two implants.

This treatment approach was selected to:

• Restore function and aesthetics in the anterior maxilla
• Provide a fixed long-term solution
• Optimise implant distribution within the available bone
• Avoid unnecessary placement of additional implants where not required

In anterior cases of this type, implant positioning is critical not only for support of the prosthesis but also for emergence profile, soft tissue contour, and overall smile aesthetics.

Surgical Phase

The four upper incisors were removed with care to preserve the surrounding tissues as much as possible. Following extraction, two implants were placed in strategic positions to support the planned four-unit bridge.

Achieving appropriate three-dimensional implant placement was essential. Particular attention was paid to angulation, spacing, and restorative-driven positioning in order to support an acceptable prosthetic outcome. Primary stability was achieved at placement, and postoperative radiographic review confirmed satisfactory implant positioning.

Osseointegration and Prosthetic Phase

A healing period was allowed for osseointegration before proceeding to the definitive restoration. During this period, the patient was monitored clinically to assess tissue maturation and implant stability.

Once integration had been confirmed, the implants were restored with a four-unit bridge replacing the four maxillary incisors. The prosthesis was designed to provide:

• Adequate anterior aesthetics
• Functional incisal support
• Acceptable phonetics
• Cleansability and long-term maintainability

The final restoration re-established continuity of the anterior dentition and provided the patient with a fixed replacement following traumatic tooth loss.

Discussion

Trauma affecting multiple maxillary incisors presents both surgical and restorative challenges, particularly in the aesthetic zone. In this case, replacement of four incisors using two implants and a four-unit bridge offered a conservative and effective fixed solution.

Success in such cases depends on careful diagnosis, prosthetically driven implant placement, preservation of hard and soft tissues, and close attention to the restorative design. Where these principles are followed, implant-supported bridgework can provide predictable functional and aesthetic rehabilitation after traumatic tooth loss.

Conclusion

This case illustrates the management of severe trauma to four upper incisors using extraction, placement of two implants, and restoration with a four-unit implant-supported bridge. The treatment provided a stable, aesthetic, and functional outcome, demonstrating a practical approach to rehabilitation in the anterior maxilla following trauma.

O post Accidental fall leading to loss of 4 front teeth apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

Comprehensive Approach to Upper and Lower Anterior Teeth Removal with Lower Bridge and Upper Implants with Temporary Denture

The management of anterior teeth requiring extraction, especially when combined with prosthetic rehabilitation, requires careful planning to balance function, esthetics, and patient comfort. A treatment plan involving the removal of both upper and lower anterior teeth, placement of a lower bridge, upper implants, and a temporary denture is a complex but effective approach.

Indications for Treatment

Patients may require this comprehensive approach due to:

• Severe periodontal disease leading to mobility or bone loss.
• Extensive decay or trauma affecting anterior teeth.
• Esthetic concerns affecting smile and social interactions.
• Need for functional restoration of bite and occlusion.

Step 1: Pre-Operative Assessment

A thorough evaluation is essential, including:

• Clinical Examination: Assess periodontal status, tooth mobility, occlusion, and esthetic requirements.
• Radiographic Analysis: Panoramic and periapical radiographs to evaluate bone quality and quantity for implants.
• Medical History: Identify systemic conditions that may impact healing or anesthesia.
• Patient Expectations: Discuss esthetic outcomes and temporary prosthetic options.

Step 2: Tooth Extraction

• Upper and Lower Anterior Teeth Removal:
  Extractions are performed atraumatically to preserve alveolar bone for future implant placement and bridge support. Care is taken to avoid excessive trauma, particularly in the anterior maxilla, which is critical for esthetics.
• Hemostasis and Socket Management:
  Socket preservation techniques, such as grafting, may be used if significant bone resorption is anticipated.

Step 3: Lower Bridge Fabrication

• Preparation of Abutments:
  Adjacent teeth are prepared to support a fixed dental bridge.
• Impression and Temporary Bridge:
  An impression is taken immediately after extractions to fabricate a temporary bridge, restoring function and esthetics during healing.
• Bridge Placement:
  The permanent lower bridge is planned following adequate healing of extraction sites, usually after a few weeks.

Step 4: Upper Implant Placement

• Implant Planning:
  Using radiographs or CBCT scans, the number and position of implants are planned to optimize support for the final prosthesis.
• Surgical Procedure:
  Implants are placed into the anterior maxilla under sterile conditions, ensuring primary stability.
• Healing Phase:
  Osseointegration typically requires 3–6 months. During this time, a temporary denture is used to maintain esthetics and function.
• Step 5: Temporary Denture
  • Immediate Temporary Denture:
    Fabricated to fit immediately after extractions, providing support to soft tissue and esthetic appearance.
  • Adjustment Period:
    Dentures are adjusted for comfort, speech, and function. They act as a transitional prosthesis until implant-supported crowns can be placed.

  Step 6: Final Prosthetic Restoration

  • Lower Bridge: Permanently cemented onto prepared abutments.
  • Upper Implant Prosthesis:
    Following osseointegration, implant crowns or a fixed bridge is attached to upper implants.
  • Occlusal Adjustments:
    Fine-tuning ensures a harmonious bite and long-term function.

  Advantages of This Approach

  • Restores esthetics and smile confidence immediately with temporary solutions.
  • Preserves alveolar bone with careful extraction and socket management.
  • Provides long-term stability with lower bridge and upper implants.
  • Minimizes patient discomfort with staged rehabilitation.

  Considerations and Risks

  • Surgical risks such as infection, bleeding, or implant failure.
  • Temporary denture may require frequent adjustments.
  • Healing times vary depending on bone quality and patient health.

O post Dental bridge or Dental Implant apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

Bridges vs Dentures: Why Fixed Solutions Change Lives** Our patient wore an old acrylic denture for years—it had a large palatal overhang that affected her speech, dropped when eating, and looked unnatural. She deserved better. **The Solution:** A 10-unit zirconium bridge fixed on 4 upper premolars.

**Why bridges win:** ✓ Fixed permanently—no movement, no dropping ✓ Natural speech and phonetics restored ✓ Eat confidently without worry ✓ Superior aesthetics with natural appearance ✓ Better oral hygiene—no hidden food traps ✓ Improved confidence and quality of life

**Our Process:** We prepared 2 premolars and restored 2 others, then fitted a temporary PMMA bridge for 4 weeks to test function, aesthetics, and speech. Once perfected, we placed the permanent zirconium bridge. The transformation? Life-changing. Dentures have their place, but when you can restore with a fixed bridge, the patient experience is incomparable. Advanced planning, precision preparation, and quality materials make all the difference.

Ready to explore your options? Book a consultation. We’re here to help you smile with confidence. #DentalBridges #SmileMakeover #AdvancedDentistry #ZirconiumBridge #DentalSolutions #FormaSmile

O post When a bridge is alternative to a denture or implants apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

A gap in your smile can be from simply missing a tooth, that never developed or losing a tooth from decay, gum disease or trauma.

The most common reason is gum disease, which is a world-wide problem even in developed countries.

Smokers and Diabetics are more prone to tooth loss through gum disease.

Gum disease affects the gums and roots of the teeth, leading to bone loss, mobility and eventually loss of teeth.

Placing a tooth back restores confidence, speech and oral function. Sometimes however it is either not a simple process or just seems very expensive.

A simple solution would be to wear an acrylic denture, but they can become loose or break and you may then be left without a tooth/teeth for a few weeks.

The trouble with dentures is that they can be unstable and do not feel like your own teeth.

Most patients would prefer a fixed solution.

Bridgework involves trimming down adjacent teeth and cementing crowns over them, and carrying Pontic or false crowns as part of a bridge.

This can be a good solution if there are good strong teeth to hold the bridge or if there are enough support teeth.

Usually however with ageing the teeth become heavily filled or loose and are not good support teeth.

A dental implant uses the bone to replace a missing teeth. The bone grows around the Titanium implant and a crown is then attached. This process is called osseointegration and was developed in 1965.

Dental implants like bridges can be used in a multiple series and replace many missing teeth.

This case above highlights a 45 year old gentleman who lost 4 upper front teeth in an accident. He was wearing a denture but due to his bite found the denture became loose.

We agreed to place 4 upper implants into the upper jaw. After 6 months we were able to attach a 4 unit fixed metal acrylic bridge onto the implant heads. All the time the gentleman wore his upper denture until the bridge was attached.

The bridge is fixed, but can be taken off by the dentist in case of a fracture.

The implants are loaded when chewing and this stops bone loss had there been no implants.

The face, smile, soft tissue and lips are all fully complimented with a fixed implant bridge.

Dental implants have a success rate of about 95% and can last from 10-20 years or longer if oral hygiene is maintained.

We offer same day teeth in conjunction with 3D scanning and planning, and you would never be without any teeth.

Sometimes we can place implants without the need for surgery and stitches.

#implant #implant #dental implant #dental bridge #bridge #missing teeth #denture alternatives #allonfour

O post How to get another 20 year smile when you have lost some teeth apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

In most cases there is not enough space for the wisdom teeth to grow, so they erupt at awkward angles and then get stuck.

This impaction can cause gum inflammation, infection, pain and swelling.

In certain cases the patient cannot open their mouth due to the infection.

In the image above the LL8 is impacted and this leads to food trapping and dental decay of the tooth next door.

The LL7 suffers from a severe cavity and will need root canal treatment or even an extraction.

Sometimes the wisdom tooth itself get decayed and causes extreme pain.

It can be difficult to floss between a buried wisdom tooth and the tooth infront.

But a poor diet with lots of sweet foods and drinks will accelerate tooth decay especially around the molars.

Dental pain can appear when it is too late to save the tooth and the tooth next door.

On a radiograph, dental decay is seen as a dark shadow or hole in the tooth.

As many wisdom teeth are positioned deeper than the second molars, then the decay in the seconds is deep and close to the nerve. Some teeth will need root canal treatment or even extraction.

Final advice is to brush and floss the molars, get a dentist to check with radiographs for any signs of infection, decay or even cysts.

In our opinion the first sign of a wisdom tooth problem should be actioned with an extraction soon after, as we have found wisdom teeth; once a problem, always a problem.

#wisdom teeth #toothache #dental extraction

O post Why you should get your wisdom teeth x-rayed part 2 apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

Over time repeatedly filled teeth can sometimes snap off at the gum.

These teeth have usually been root treated as well, which makes them prone to fracture. The unfortunate patient cannot smile or chew fully.

Not all is lost however. Dental implants such as Nobel Biocare are the answer.

A non-traumatic removal of the tooth can allow bone to be preserved, and then implants placed in the tooth sockets, or 3 months after healing.

In this case this gentleman in his 70s had snapped off the UR 65 bridge and his UR4 was already missing.

We removed the broken roots and placed bone grafting material (Bioss) and 2 Nobel Biocare implants at the same time.

3 months later we removed the healing caps to check the implants and all seemed integrated.

A metal porcelain bridge was then attached to the 2 implants as 2 units carrying the floating tooth UR4 as a floating pontic.

The smile and chewing facility was restored and the patient went back to enjoying his going out and socialising.

#implants #dental implant #implants #all on 4

# missing teeth

O post When the tooth is completely gone apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

Teeth can be repeatedly filled when broken, with bigger and bigger fillings.

Eventually the nerve may become damaged or the tooth fractures beyond repair. This can end up as months of pain and discomfort.

A gum boil can be the first sign of nerve infection.

Sometimes you can receive unsightly fillings that stand out when you smile.

So what should one do?

Firstly an x-ray could be done to see why the tooth is failing. Sometimes you can carry out root canal treatment and then crown the teeth. But there is no guarantee and the teeth could still fail underneath.

Many NHS dentists would even find the teeth above too difficult to fix, let alone remove.

If a tooth is removed then you can get tooth drift leading to an unstable occlusion.

Our recommendation is if the tooth is too expensive to repair, then replace it with an implant crown.

Placing an implant is less painful than taking a tooth out.

We drill a small hole through the gum into the bone. Bone does not contain nerves so you don’t get any pain. The bone grows around the implant.

The Titanium implant rarely fails as opposed to deep fillings or root canal treatment.

Within 3 months you can have crowns attached to the implants and your smile is restored. The crowns are attached with screws and no messy glue. The teeth are also easy to floss and to keep clean.

If you ever get a porcelain fracture, the dentist can unscrew the crown and get it repaired.

#implant #dental implant #failing teeth #lost tooth #smile

O post Replacing failing teeth apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

Teeth can be repeatedly filled when broken, with bigger and bigger fillings.

Eventually the nerve may become damaged or the tooth fractures beyond repair. This can end up as months of pain and discomfort.

A gum boil can be the first sign of nerve infection.

Sometimes you can receive unsightly fillings that stand out when you smile.

So what should one do?

Firstly an x-ray could be done to see why the tooth is failing. Sometimes you can carry out root canal treatment and then crown the teeth. But there is no guarantee and the teeth could still fail underneath.

Many NHS dentists would even find the teeth above too difficult to fix, let alone remove.

If a tooth is removed then you can get tooth drift leading to an unstable occlusion.

Our recommendation is if the tooth is too expensive to repair, then replace it with an implant crown.

Placing an implant is less painful than taking a tooth out.

We drill a small hole through the gum into the bone. Bone does not contain nerves so you don’t get any pain. The bone grows around the implant.

The Titanium implant rarely fails as opposed to deep fillings or root canal treatment.

Within 3 months you can have crowns attached to the implants and your smile is restored. The crowns are attached with screws and no messy glue. The teeth are also easy to floss and to keep clean.

If you ever get a porcelain fracture, the dentist can unscrew the crown and get it repaired.

#implant #dental implant #failing teeth #lost tooth #smile

O post Replacing failing teeth apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

1. Experts in our area

With over 30 years’ experience in dentistry, cosmetic dentistry, Invisalign & Implantology you are in very experienced hands. Here at Forma we offer a personal tailor-made experience in a stress-free, relaxing environment and using the most advanced dental and cosmetic treatments currently available.

2.Variety of different dental treatments offered

Invisalign – Forma has provided Invisalign invisible braces for over 15 years, we have successfully treated over 1100 patients. With Invisalign clear aligners it’s easy to achieve the perfect smile with minimal impact to your lifestyle. With custom-made aligners that you change every 2 weeks yourself at home and check-ups every 6-8 weeks, having your teeth straightened could not be easier. We’re confident in the technology Invisalign’s clear braces provides and our patients are always satisfied with their finished smile.

Implants – With the most up to date technology and full assessment including CT & X ray scans we can provide a long-term solution for missing or failing teeth. Using a titanium screw placed directly into your jaw bone which acts as the tooth root, we can then permanently and securely fix a new porcelain tooth/teeth onto this. These teeth are always a similar size shape and colour to the rest of your teeth. We also offer All on 4: teeth in a day. We can replace your failing teeth with implants and a fixed bridge on the same day.

Smile makeovers – Is literally creating a new smile. When teeth are worn, discoloured, misshapen, we can replace these with new crowns/veneers giving you an instant perfect smile. At Forma all our dental crowns are made from porcelain for longevity, some of our smile makeovers have lasted over 30 years. We can give you your perfect smiles in just 3 appointments; consultation, preparation and final fit.

Forma Beauty – Offering a wide range of anti wrinkle treatments. Dermal fillers to create volume and vitalise the skin and cryotherapy services to rejuvenate the skin.

3. Central London location

Our London practice is situated in the heart of the city at 65 London Wall, very near to Liverpool Street Station, easily accessible via public transport.

All our treatments are personal and tailor-made, we offer a one-to-one consultation at the surgery but are available for any queries by phone or email. We want to make sure your treatment is easy and that you always feel help is never far away.

4. Thousands of happy patients

Forma has been established for over 30 years; within that time we have created thousands of new smiles. Our aim is to turn your frowns into smiles. We want to see beautiful, straight teeth behind confident, healthy smiles. Check out our website for before & after photos and patient reviews.

 5. Evening and weekend appointments

Here at Forma we understand that life sometimes just gets in the way. So, we want to make it easier for you make your appointments/checkups so therefore we offer evenings and Saturday appointments.

6. Interest free payment plan options

Once we have met you at our initial consultation, we will go through your treatment options and the different ways to pay.  We offer interest free payment plans if you would like to spread the cost of your treatment.

7. Removable retainers

Once you have completed your treatment with Invisalign, we want to make sure your new perfect smile stays in place. We offer you 3 sets of Invisalign Vivera clear retainers which will last up to 10 years, for you to wear at night.

8. Free teeth whitening.

Once you have finished your treatment, we give you complimentary Philips Zoom teeth whitening, which you will do in the comfort of your home. This adds the finishing touches to your new perfect smile.

FormaSmile

O post 8 Reasons to choose FormaSmile. apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.

Missing teeth spaces can allow other teeth to drift sideways on downwards into the space; this ca cause occlusal and even joint problems.

Missing teeth can also create aesthetic problems, but the biggest drawback is the inability to enjoy your food. To many people, eating is the culmination of all the senses.

So when you cannot chew your food, or enjoy a hearty meal, then you can always ask us for advice. There are many options.

Replacing these missing teeth by way of bridges fixed over existing teeth is a possibility, but this can be very destructive and reduces the life expectancy of the natural teeth. Sometimes a tooth may need subsequent root canal treatment.

Dentures can be made, but they need replacing, can become loose or even break. They are usually made of acrylic or metal acrylic with metal clasps. Nowadays we can also make flexible dentures that stretch over the teeth and do not need clasps.

By way the best way of replacing teeth is using implants. Implants can support many teeth, maintain bone levels and being fixed are a natural way of replacement.

Implants are made from Titanium alloy, are bio-inert and have been used in dentistry for over 50 years.

In the first of a series of articles we will be discussing numerous case studies.

Patient AB attended with 2 unrestored implants placed at another clinic, unfortunately the clinic had closed down. Lower Right 654 were missing.

We were using the same Nobel active implant system and we were able to help. We assessed the patient, his occlusion and his aspirations.

The patient had the implants placed 6 months ago and had lost his temporary acrylic bridge after it had fractured.

One of the implants had been placed very close to the canine tooth, which could jeopardise the nerve of the canine and also the long term integration of the implant.

We used impression posts attached to the implants and took silicone impressions.

2 weeks later a metal porcelain bridge was attached to the implants by way of integral implant screws. patient was very happy to be able to chew on both sides; now he is considering Invisalign.

Dental implants if paced with care and attention can last a lifetime.

O post Restoring missing teeth with implants apareceu primeiro em Forma Smile | Dentist in London - Dental Clinic London - Invisalign Clinic in London - Invisalign Specialist - Dental Implants in London - Dental Care - Dental Boutique based in Central London EC2.