- 17 Gerard St, Cremorne, Sydney, NSW, 2090
- I Mon to Fri: 8:00AM-6:00PM Sat: 8:00AM-12:00PM
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
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
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.
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
NoteLower arch
- Worn upper & lower front teeth
- Step in lower left quadrant
- Discoloured and failing restorations: fillings, veneers, crowns & bridgework
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).
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
- No treatment: this is not an option as the restorations are failing and affecting longevity of supporting teeth
- Repair existing restorations and make removable partial denture: this is a temporary measure and not accepted by the patient
- Fixed option: tooth supported crowns and bridgework, described below
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
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
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
- Clin. Dent (Pros) Uni Syd, FRACDS, MRACD (Pros)
