Chief concerns

Improving the aesthetic apperance of her smile. The concern is to improve the upper arch shape and smile line as well as tooth colour. This lovely patient wants to smile with confidence.

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 defect that required augmentation to create base for tooth replacement. Since the existing design of the crowns and bridgework has served well last 20 years, we decided to replace the restorations and improve on the design, using only tooth supported bridgework as there was no need to complicate the treatment and increase the costs by dental implants.

• Discoloured lower porcelain veneers and dark triangles.
• There is lack of symmetry and harmony.
• The porcelain veneers have been recemented number of times.
• Reduced upper lip support.
• The existing restorations have been in place for some time. However, patient works in a corporate world, felt it was time to rejuvenate her smile as it affected her confidence.

Dark spaces as edentulous ridges have undergone resorption over time: causing food impaction. The existing restorations have been repaired subsequently. Porcelain veneers have been recemented a number of times. We have unacceptable aesthetics. In general, whenever possible we 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.

Diagnosis

Unacceptable dental aesthetics due dissatisfaction with failing fixed restorations and general tooth discolouration. Our Aim: to improve the aesthetics of both arches: Tooth shape, display, tooth colour, length, symmetry and smile line in general, replacing existing veneers and crowns with new porcelain technology.

This was accomplished with minimal discomfort to the patient and Mrs. M. never left the practice with missing teeth. The provisional restorations constructed were instrumental in final aesthetic and functional outcome.

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.

Removal of failing bridgeworks

1. Placement of provisional crowns and bridgework.
2. Finalize the treatment with tooth supported porcelain veneers. crowns and bridgework in the upper arch. The Provisional restorations provided that important confidence for normative function comfort & aesthetics.

Procedure & Results

The work was completed in two months. Provisional restorations Mrs M approving the colour and shape. Note improvement in smile line, lip outline, support and thickness. Final treatment outcome: we have restored esthetics comfort and function and we have a happy patient.