Advanced Rehabilitations


There are often situations where patients require a more advanced approach to their treatment. There are a variety of areas where this can apply. The starting point for most of these cases is a consultation with one of our Prosthodontists, Dr Seamus Sharkey or Dr Máire Brennan. Prosthodontists are the only dentists or specialists who are trained to look at the overall picture and come up with a complete diagnosis and tailored treatment plan for complex cases. Other specialists are often involved in the provision of these complex treatments and the Prosthodontist will co-ordinate with these team members to ensure delivery of expert multidisciplinary care. Here are a sample of some of the scenarios that we often come across:


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Full Mouth Rehabilitation

Full Mouth Reconstructions:
Some patients require a more complex, advanced approach to restoring their dentition.

These people often have such poorly functioning dentitions that they need to be completely rebuilt. This deterioration of their teeth can occur for a number of reasons such as neglect, damaging habits such as grinding, gum problems, genetic disorders and trauma. Very often only individual problems are dealt with and the overall picture is not taken into account. This can result in years of wasting money and a poor quality of life for the unfortunate individual.

What is usually required here is a full picture of the problem and long term treatment plan. This usually involves a number of diagnostic appointments in which all the information is gathered and records and models of your teeth taken to allow a complete plan to be drawn up. This plan will aim to give you many years of function, aesthetics and comfort and allow you to maintain your mouth in a healthy state.


Sample Case:
Stone models are made from impressions of the teeth to allow planning and diagnostics outside of the patients mouth. These are mounted on a device called an Articulator which is able to replicate the movements of the jaws.


Before Crowns After Crowns

1. Stone Models of teeth

2. Models of Patient on Articulator


A variety of x-rays and other tests may be needed to fully diagnose the problems and come up with solutions. These can include simple 2-dimensional images of individual teeth or complex 3-dimensional scans using state-of-the-art CT xrays and planning software. These 3-D images give unrivalled information about the condition of the bone and teeth and allow us to simulate the position of the future teeth.


Before Crowns After Crowns

3. Computer model of upper jaw

4. Teeth superimposed on jaw


Once all the information is gathered and examined a tailor made plan can be constructed for each individual case. This may involve a variety of treatments such as Crowns, bridges, implants and fixed or removable implant prostheses. A sample of some of these types of cases are shown below:


 After Crowns After Crowns

5. Smile Before rehabilitation

6. Teeth badly positioned and broken down before rehabilitation

After Crowns After Crowns

7. Smile After Rehabilitation

8. Teeth After rehabilitation using implants, crowns and bridges.


Other examples of different cases:

After Crowns After Crowns

9. Before Smile of patient with old crowns and damage to her teeth

10. Before picture of damaged teeth and old crowns

After Crowns After Crowns

11. After Smile with crowns and veneers to restore teeth

12. After reconstruction using combination of porcelain and gold crowns at patients request

After Crowns After Crowns

13. Severely broken down natural teeth

14. Implant overdentures used to restore health, appearnace and function


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Teeth in a day

In cases where implants are being placed for patients there is often the option of trying to have the teeth placed onto the implants on the same day. This is usually done in patients who have no teeth left or where they are soon to be extracted. This is very appealing to people who feel that they do not want to wait for fixed teeth for any significant period of time. This requires very careful planning from the start and a number of planning appointments and use of advanced dental CT x-rays to assess your bone levels will be needed to assess your suitability.


Before Crowns After Crowns After Crowns

1. Old worn dentures

2. Lower jaw with no teeth

3. Before facial appearance


After completing the initial planning appointments the dental implants are gently placed into the jaw under local anaesthetic, or for patients who are nervous with the help of Sedation. On the same day a custom made temporary fixed bridge is fitted onto the implants. The case below shows five implants that have been placed and the teeth connected to it. This temporary bridge is worn for about 3 months until the bone is fully mature around the implants. The final implant bridge is then made over the next visits and all the while the patient gets to enjoy the benefit of teeth in a day.


Before Crowns After Crowns After Crowns

4. Immediate Fixed teeth to be fitted on day of surgery

5. Fixed teeth fitted on same day as surgery

6. After facial appearance


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Zygomatic Implants

Dental implants need enough bone in the jaws to be able to integrate and work properly. In some cases there is a small amount of bone missing and it is possible to build up or augment the bone in these areas. In some people however there is not enough bone left for this procedure.


Zygomatic implants offer an alternative for these cases. This procedure uses bone in the cheek to anchor longer implants that can then be used to support a fixed or removable implant prosthesis. There is even the possibility to use these implants to provide a temporary fixed prosthesis on the same day as the surgery (Teeth in a day).


Before Crowns After Crowns

1. Zygomatic Implant

2.Before Surgery

Before Crowns After Crowns

3. Final Fixed upper and lower prostheses

4. Final smile after fixed prosthesis on Zygomatic implants


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Sleep Apnoea

Snoring and sleep apnoea appliances:

Snoring can be a very annoying and difficult habit for others to live with but it may also be an indicator of a potentially serious underlying condition known as Obstructive Sleep Apnoea (OSA). This occurs when there is a partial or full blockage of your airway. Your brain will then register a lack of oxygen and respond with muscle spasms. You will then often partially wake with a start, resume breathing and then return to sleep. This can occur several times throughout the night, causing a disruptive sleep.


OSA left untreated is potentially dangerous. Risks include heart attacks, strokes, irregular heartbeat, hypertension, loss of libido and frequent night-time urination. Furthermore, OSA causes daytime sleepiness that can result in accidents at work or whilst driving, lost productivity and interpersonal relationship problems. OSA is particularly common in males and in overweight patients and according to the American National Sleep foundation affects more than 18 million people.

How can obstructive sleep apnoea be treated?
The first stage in treatment is effective diagnosis by a trained sleep professional. This may involve a number of tests to assess the severity and type of sleep apnoea that is occurring. There are several treatment options available including weight loss, postural changes for sleeping, positive airway pressure devices and dental sleep appliance therapy.

Dental Sleep Appliances

  1. Dental appliance therapy is scientifically proven as an effective and comfortable treatment for snoring and mild to moderate sleep apnoea.
  2. The main way that appliances work is by preventing the tissues at the back of the throat and the base of the tongue from collapsing back into the airway.
  3. Sleepiness and drowsiness due to obstructive sleep apnoea (OSA) can be effectively treated with sleep apnoea treatment and a normal sleeping pattern can then be re-established.

Dental appliances can be very successful in the treatment of sleep apnoea and are often used in conjunction with other treatment modalities. There are however, a number of factors that need to be considered from a dental viewpoint:

  • Any form of appliance can cause damage if inappropriately fitted and can damage healthy teeth or accelerate existing disease. Therefore a thorough dental examination is mandatory before an appliance is made.
  • Most sleep appliances use an altered lower jaw position to posture the tongue forward to open the airway. If this is done incorrectly it can induce Tempromandibular Joint (TMJ) pain and even cause unwanted tooth movement.
  • Use of these appliances need to be carefully monitored and re-assessed by a dental professional trained in their use such as a prosthodontist.

Sleep Appliance Therapy at Citygate Specialist Dental Clinic:
In a recent report published in SLEEP, VOL. 29, NO. 2, 2006, the American Academy of Sleep Medicine makes the following recommendation:

"Oral appliances (OAS) are indicated for use in patients with mild to moderate obstructive sleep apnoea, who prefer them to cotinuous positive airway pressure (CPCP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPCP is indicated wherever possible for patients with severe obstructive sleep apnoea before considering OAS. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the over-all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures."

Dr Sharkey and Dr Brennan, in conjunction with a sleep medicine team, will discuss the various options available to you and should an appliance be needed a thorough dental, occlusal and TMJ examination will be carried out. A number of appointments are needed to properly record the jaw position and construct the appliance. Once fitted a number of review appointments will be used to assess the appliances effectiveness and adjust it if necessary. This will be followed up with close co-ordination with the sleep medicine team.


What are the benefits of dental appliance therapy?

  • You and your partner can look forward to a quiet night of sleep.
  • Wake up refreshed and ready to face the day.
  • Improved quality of life through greater vitality and participation.
  • Improved work performance due to greater concentration and energy levels.
  • Decreased risk of fatigue-related vehicle and work accidents.
  • Decreased risk of heart disease, stroke and blood pressure problems.

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Advanced Rehabilitations

After reviewing the different types of advance rehabillitations above we would be happy to discuss with you in more detail. If you would like any further information or would like to meet with one of our team members in confidence, please do not hesitate to contact us.


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