Designer Smiles
CASE STUDY – 18 VICKI

Dental facelift: Case Study

Failed aesthetics: failing crowns and bridgework affecting patients comfort, function and aesthetics. This is further compounded by the presence of high smile line.
Treatment: reconstruction of maxilla (upper arch)and mandible (lower arch) using tooth supported and implant supported crowns and site augmentation (soft and hard tissue grafting) where teeth have failed that require removal.

Chief Concern

Patient is self-conscious about her teeth. “When I am talking I look like I don’t have teeth”. “They are discoloured and the existing crowns are bulky”. “I’m in marketing and would like to do video presentations.” “I would like to improve my smile”.

This lovely patient wants to smile with confidence

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COMPLAINTS &EXPECTATIONS

    • “I am discontent with my uneven smile and old crowns”
    • “I am in public relations, and natural aesthetics is important to me”
    • “Discolouration and tooth wear”
    • General tooth wear now noticeable
    • Replacement of existing TSFDP (tooth supported fixed dental prosthesis-bridgework)

This study will show

    • Complexity of treatment
    • Treatment outcome
    • Patient’s assessment
    • Please refer to the video provided
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Initial Presentation

Mrs. V was referred by her dentist, seeking specialist’s opinion and treatment in relation to fixed option of replacing failing but well maintained fixed crowns and bridgework

We have unacceptable aesthetics and function. Its surprising to see how much patients can tolerate with worn restorations affecting dentofacial aesthetics. I guess we all are busy in our lives, looking after the family and finally when everyone is ok, it time for us.

 

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NoteUpper arch

  • Minimal tooth display during rest and speech
  • Canted smile line
  • Unnatural smile line
  • During smile & speech dynamics showing discoloured and failing restorations: fillings, veneers, crowns & bridgework
  • Reduced upper lip support
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NoteLower arch

  • Worn upper & lower front teeth
  • Step in lower left quadrant
  • Discoloured and failing restorations: fillings, veneers, crowns & bridgework
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Diagnosis:  Unacceptable dental aesthetics & function due dissatisfaction with failing fixed restorations and general discolourationincluding an uneven occlusal plane: creating a perceived aesthetic disturbance

Our Aim:  to improve the aesthetics of occlusal plane (canted smile line),tooth shape, display, tooth colour, length, symmetry and smile line in general, as well replacing existing crowns and bridgework.

This was accomplished with minimal discomfort to the patient and Mrs. V. Never left the practice without missing teeth. The provisional bridgework as both aesthetic and function (please Videos provided).

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Diagnosis:  Unacceptable dental aesthetics & fucntion due dissatisfaction with failing fixed restorations and general tooth discolouration

Our Aim:  to improve the aesthetics of upper arch: Tooth shape, display, tooth colour, length, symmetry and smile line in general, as well replacing missing teeth:23,24,14,16 using implant supported crowns and replacing existing faulty crowns with new ceramic crowns.

This was accomplished with minimal discomfort to the patient and Mrs. T. Never left the practice without missing teeth. The provisional bridgework as both aesthetic and function (please Videos provided).

Treatment

Following with discussion of all risks and treatment modalities with our patient that included

  1. No treatment: this is not an option as the restorations are failing and affecting longevity of supporting teeth
  2. Repair existing restorations and make removable partial denture: this is a temporary measure and not accepted by the patient
  3. Fixed option: tooth supported crowns and bridgework, described below

 

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Placement of provisional crowns and bridgework

Finalize the treatment with implant and tooth supported crowns and bridgework in the upper arch.The Provisional restorations for that important confidence for normative function comfort & aesthetics

Laboratory: Reconstruction of upper arch: implant supported bridgework and tooth supported crowns

Clinical: Reconstruction of upper& lower arches: using tooth supported porcelain veneers, crowns and bridgework

 

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Procedure &Results

Upper arch only completed at this stage, see next page

Smile completed using combination of porcelain veneers. Crowns and bridgework

Note the difference in shade between the arches.

Therefore, in most cases involving such a high level of reconstruction we need to consider both arches to create that level of high aesthetics and function as requested by this elegant patient

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Completion of both arches

Creating symmetry & harmony by levelling the smile line, improving: arch form tooth  formcolour, and display

Smile completed using combination of porcelain veneers. Crowns and bridgework

Porcelain veneers placed on upper and lower front six teeth

Crowns and bridges on the back teeth

Improvement in lip thickness & support in combination of correcting protruding maxillary central incisors

Final treatment outcome: we have restored aesthetics comfort & function.

However most importantly we have complemented our lovely patient’s facial aesthetics.

Final

treatment outcome and we have a confident and happy patient.

Dr. Sarkis Nalbandian

Registered Specialist   

Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Pros) King’s College, Uni London

  1. Clin. Dent (Pros) Uni Syd, FRACDS, MRACD (Pros)
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