This patient had severe failing crowns and bridgework which affected her comfort, the function of her mouth and the aesthetics of her smile. This was further compounded by the presence of high smile line.
My treatment of this case involved reconstruction of the upper teeth arch (maxilla) using tooth supported, and implant supported, crowns and soft and hard tissue grafting (site augmentation) where teeth have failed that require removal.
This study will show:
The patient was referred by her dentist, seeking a specialist’s opinion and treatment in relation to a fixed option of restoring missing teeth and failing dentition, as well as tooth supported crowns. The loss of teeth from failing bridgework had left considerable soft and hard tissue defects that required augmentation to create a base for tooth replacement.
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, which creates natural aesthetics. When this is difficult I use pink porcelain to simulate gum aesthetics. In many ways pink porcelain is more predictable than large grafting procedures, depending on the cases treated.
Our chief concern in this case was improving the aesthetic appearance of the patient’s smile. To improve the upper teeth arch shape and smile line, as well as teeth colour. She wanted to smile and chew her food confidently. She was specifically concerned about recent dental work, by another dentist, causing protrusion and canting of her upper central incisors creating an aesthetic disturbance, lip incompetence and a speech impediment.
You can see the ridge defect in the critical aesthetic zone, currently replaced by provisional removable prosthesis. This site required surgical augmentation prior to implant placement. This allows implant to be placed in the correct dimension for optimal construction and emergent profile of the final crowns and bridgework.
My diagnosis in this case was unacceptable dental aesthetics and function due dissatisfaction with failing fixed restorations and general tooth discolouration.
My aim was 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 she left the practice with teeth in her mouth for the duration of the treatment. The provisional bridgework was both aesthetic and functional.
I discussed of all risks and treatment modalities with my patient that included:
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 my patient for normative function comfort and aesthetic appearance. We tested the new provisional restorations and refined it for her acceptance that guided the final desired aesthetic outcome.
Unfortunately, this work was initially completed by a dentist with minimal qualifications and experience. Hence the reason for the patient seeking a specialist prosthodontist for correct diagnosis and treatment planning; providing an optimal outcome for her.
The final treatment outcome: I have restored aesthetics comfort and function for this patient. However most importantly I have complemented my lovely patient’s facial aesthetics with her new smile. Hence I use the term: dentofacial rejuvenation
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