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.
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
The patient was referred by her dentist, seeking a 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. It’s 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.
Diagnosis: Unacceptable dental aesthetics and function due to dissatisfaction with failing fixed restorations and general discolouration including 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 she never left the practice without teeth. The provisional bridgework serving as both aesthetic and functional.
Following with discussion of all risks and treatment modalities with our patient that included
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 and aesthetics.
Laboratory: Reconstruction of upper arch: implant supported bridgework and tooth supported crowns.
Clinical: Reconstruction of upper and lower arches: using tooth supported porcelain veneers, crowns and bridgework.
Upper arch only completed at this stage. Smile completed using combination of porcelain veneers. Crowns and bridgework. There was a 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 and harmony by levelling the smile line, improving: arch form, tooth form, colour, 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 and support in combination of correcting protruding maxillary central incisors.
Final treatment outcome: we have restored aesthetics comfort and function.
However most importantly we have complemented our lovely patient’s facial aesthetics.
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