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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) using tooth supported and implant supported crowns and site augmentation (soft and hard tissue grafting).

This study will show

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

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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.

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.

When this is difficult we use pink porcelain to simulate gum aesthetics. In many ways pink porcelain is more predictable than large grafting procedures, depending on cases treated.

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 and chew her food confidently.Patient was specifically concerned about recent dental work by another dentist casung protrusion and canting of upper central incisors creating an aesthetic disturbance, lip incompitance and speech impediment.

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Note the canter midline, unnatural teeth: colour, form, progression & gum line

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Note the ridge defect in the critical aesthetic zone currently replaced by provisional removable prosthesis. This site required surgical augmentation a priro to implant placement. This allows implant to be placed in correct3 dimesnion for optimal constrcution and emergence profile of the final crowns and bridgework.

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

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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).

The provisional restorations for that important confidence for normative function comfort & aesthetics.

 

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: implant & tooth supported crowns and bridgework, described below Removal of failing bridgeworks

Placement of provisional crowns and bridgework

  1. Placement if implants at sites: 22,23,14 & 16
  2. Finalize the treatment with implant and tooth supported crowns and bridgework in the upper arch.

Procedure &Results

The work was completed in six months as it takes this long for grafts (bit longer) and implants to integrate with bone. Is best not to rush biology and allow optimal healing.

The provisional restorations provided that important confidence for our patient for normative function comfort & aesthetics. We tested the new provisional restorations and refined it for patient’s acceptance that guided for final desired aesthetic outcome.

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Final treatment outcome: we have restored esthetics comfort & function and we have a happy patient

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

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

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

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

Hence the term: dentofacial rejuvenation by Dr Sarkis Nalbandian

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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 (Prosth) King’s College, Uni London

D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)