Dental facelift: Case Study2 worn smile/dentition Failed aesthetics

Full mouth rehabilitation on a limited budget: Long term interim restorations

Failed aesthetics: failing crowns and bridgework affecting patients comfort, function and aesthetics. This is further compounded by the presence of high smile line and reverse smile line created by abnormal tooth wear from loss of posterior (back teeth) support and bruxing (grinding teeth together: nighttime and or day time). Naturally dietary influence of tooth surface loss has been accounted for this lovely patient.

You notice the poor adaptation of upper and lower removable dentures. Fractured teeth and failing restorations.

The sharp teeth were most uncomfortable for the patient. Uneven tooth wear on both arches.

The excessive teeth wear and loss of lower facial height (we refer this tor educed occlusal vertical dimension) that must be restored to allow correct tooth anatomy, arch level and position development and restore normal speech as this lovely patent’s speech was also affected due to short and sharp teeth.

Treatment: reconstruction of maxilla (upper arch) and Mandible using tooth supported direct composite restorations bonded to existing teeth. Patients own removable partial dentures were modified and refitted.

This study will show

Complexity of treatment
Treatment outcome
Patient’s assessment
Please refer to the video provided.

Initial Presentation

Patient was referred by her sister an existing patient of Dr Nalbandian, seeking specialist’s opinion and treatment in relation to fixed option of restoring worn, missing teeth and failing restorations (dental fillings).

The loss of back teeth initially replaced with partial dentures are inadequate: providing no support and in may ways contributing for accelerated wear of maxillary (upper) front teeth with dire aesthetic and functional consequences. You note that the porcelain crown on upper lateral incisor is not affected, while the remainder of dentition are highly affected. This dissimilar wear will eventually exert critical force to fracture tooth 12 with past root canal therapy causing eventual loss of tooth 12 and further wear, eventually rendering entire dentition to costly full mouth crowns and bridgework rehabilitation.

Due to current state of finances for this patient direct composite reconstructions were chosen for the following reasons

Immediate result
Assessment of patient’s adaptation to new bite level and make necessary refinements to accommodate these changes.

Chief concerns:“ I want to chew my food and smile”

improving the aesthetic apperance of her smile. requiring improvement, “fresher look”. The concern is 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.

Diagnosis: Unacceptable TSL (tooth suurface loss), dental aesthetics & function and dissatisfaction with failing restorations causing fucntional and aesthetic disturbance.

Our Aim:To restore lower facial height and restore speech. Furthermore, in this process also to improve the aesthetics of upper and lower arches: tooth shape, display, tooth colour, length, and symmetry and smile line in general reconstructing teeth with tooth surface loss.

This was accomplished with minimal discomfort to the patient and Mrs. R. The procedure was completed in one long visit (please Videos provided).ONE VISIT SMILE LIFT™

Treatment

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

No treatment is not an option, since restorations are failing: affecting longevity of supporting teeth
Repair existing restorations and make removable partial denture: this is the best treatment due to financial reasons and constitutes good treatment for next few years and was accepted by the patient.
Future reconstructions using crowns, bridges and implants can be considered, however for this lovely patient the proposed treatment was sufficient at this stage.

Procedure &Results

The work was completed in onevisit. Naturally we carried out diagnostic mock up in the mouth to assess aesthetics and speech, followed by completed the diagnostic wax up in the laboratory as a part of assessment for the amount of bite opening is required and this was transferred in the mouth and both jaws restored to correct facial height in one long appointment.