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Complex Dental Aesthetics
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Complex Dental Aesthetics - Patient Story

Failed aesthetics: failing crowns and bridgework affecting patient’s comfort, function and aesthetics. This is further compounded by the presence of a 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.

This study will show:

  • Complexity of treatment
  • Treatment outcome
  • Patient’s assessment – refer to the video provided

Chief concerns: improving the aesthetic apperance of her smile. To improve the upper arch shape and smile line as well as tooth colour. This lovely patient wants to smile and chew her food confidently. She was specifically concerned about recent dental work by another dentist causing protrusion and canting of upper central incisors creating an aesthetic disturbance


Initial Presentation


Patient was referred by her dentist, seeking specialist’s opinion and treatment in relation to fixed option of restoring missing teeth and failing dentition as well as tooth supported crowns. The loss of teeth from failing bridgework has left considerable soft and hard tissue defects that required augmentation to create a base for tooth replacement.

We have unacceptable aesthetics and function. It’s surprising to see how much patients can tolerate with broken down dentition. I guess we all are busy in our lives, looking after the family and finally when everyone is ok, it is time for us.

In general, whenever possible, I would like to replace, or at least get close to the foundation bone and gum tissues to allow optimal tooth position in the arch that creates natural aesthetics.

Note Upper arch: broken-down dentition, discoloured crown margins, unnatural teeth: colour, form, progression and gum line.

Lower arch: Missing molars and premolars on lower right side.

Diagnosis: Unacceptable dental aesthetics and fucntion due to 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 as 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 she never left the practice without teeth. The provisional bridgework being both aesthetic and functional.

Initial Presentation

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: implant and tooth supported crowns and bridgework, described below
    1. Placement if implants: lower arch (at sites: 36, 44, 45 & 46) and upper arch (14, 16, 24, 25 & 27).
    2. Finalise 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 and aesthetics.

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

    Clinical: Reconstruction of upper arch: implant supported bridgework and tooth supported crowns.


Procedure & Results


The work was completed in six months as implants were given time to integrate with bone. Is best not to rush biology and allow optimal healing.

Final treatment outcome: we have restored aesthetics, comfort and function and we have a happy patient.

Unfortunately, this work was initially completed by a dentist with minimal qualifications and experience. Hence the reason for patient seeking a specialist prosthodontist for correct diagnosis and treatment planning; providing an optimal outcome for this lovely patient.

Note improvement in lip thickness and support in combination with correcting protruding maxillary central incisors.

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

However most importantly we have omplemented our lovely patient’s facial aesthetics. Hence the term: dentofacial rejuvenation.

Final treatment outcome and we have a confident and happy patient.

Thank you for taking the time to explore this patient’s story. I hope this gives you an idea of what I can do for you if you are having difficulty and need help, because there is always hope.

Dr. Sarkis Nalbandian
Visiting Professor YSMU
Specialist Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth) FIADE, FPFA