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Teeth Fixed From Childhood Trauma

Teeth Fixed after Childhood Trauma - Patient Story

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A childhood accident, involving accidentally drinking caustic soda when she was 2 years old, resulted in extensive scarring inside this patient’s mouth and throat. It led to her teeth not aligning properly and the partial loss of her tongue. This caused immense problems with chewing and speech over the years and the patient was unhappy with her resulting appearance. She had several skin grafts and reconstructions over the years which had helped to some degree.

Due to the scarring, her lower facial height growth has been affected. The alveolar bone that houses the teeth had failed to develop properly, preventing natural lip support and increased facial folds creating an aged appearance for this young patient. You would agree that she appears much older than her true age as a result of the childhood accident.

Surgeries during last 3 years for tongue lifting and muscle expansion, unfortunately had not been successful. The scarring in her mouth has affected tongue volume, mouth volume and reduced normal jaw–teeth development: reduced facial height (reduced occlusal vertical dimension).

She came to me, a registered specialist dentist in prothodontics and implant surgery, to improve her smile and eventually replace several missing teeth. She had waited over 30 years for a solution to her problem and I did not want to disappoint her.

This case required the following treatments:

  • reconstruction of maxilla (upper arch) and mandible using initially orthodontic intrusion;
  • levelling and positioning maxilla (upper arch) in correct position to restore the lost facial height(volume), followed restorative correction.

Each step was meticulously planned out following the specifications of her diagnostic mock up. This was always in consultation the patient so that she had a say in how she would look, the comfort level of her new teeth and how it affected her speech.

This study will show you:

  • Complexity of treatment
  • Treatment outcome
  • Patient’s assessment (in the video)
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Initial Visit

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She was referred by her employer and friend, seeking a specialist dentist’s opinion and treatment in relation to a fixed option of restoring her appearance and mouth function (dentofacial aesthetics). The scarring from childhood trauma had left considerable soft and hard tissue defect reducing oral access for reconstructive dentistry.

In consultation with myself, she wished to improve the aesthetic appearance of her smile, improve the upper arch shape and smile line as well as the colour of her teeth. She wanted to smile with confidence and feel beautiful.

My diagnosis of this case: Unacceptable dental aesthetics and function due to dissatisfaction with failing fixed restorations, general tooth discolouration and peri-oral scarring due to childhood accident.

Diagnostic mock-up: improved confidence & smile

Following the diagnostic mock-up, we achieved the following;

  • Improved upper arch form teeth display
  • Improved level of teeth display, shade and shape of teeth.
  • Symmetry across the midline
  • Arch width & lip/facial support improved lip symmetry
  • Optimal speech, comfort and smile dynamics.

Our Aim: to improve the aesthetics of upper and lower arches: Gum level, arch shape and position, tooth shape, display, tooth colour, length, symmetry and smile line in general, as well as replacing missing teeth. The aim was to complement her facial aesthetics.

This was accomplished with minimal discomfort to the patient.

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Treatment

I discussed all the risks and treatment modalities with our patient that included:

  • Levelling and alignment with an orthodontic treatment. The primary aim was to correct the dental/facial midline, proclining upper front teeth, improving upper & lower facial profile.
  • Frontally it is evident that maxillomandibular complex is “retroclined and rotated” within the facial frame. The ideal treatment is orthodontic and orthognathic surgery followed by restorative correction. However, since the patient had multiple dental-surgical treatments in the past, time factors, life factors, were all taken into account for patient centered treatment planning. Therefore, prolonged surgical-orthodontic treatment at this stage in her life was not an option.
  • No treatment: this was not an option as the restorations were failing and affecting longevity of supporting teeth.
  • Repair existing restorations and make removable partial denture: this would have been a temporary measure and was not accepted by the patient.
  • Orthodontic treatment to intrude and procline upper teeth: accepted by the patient.
  • Finalize the treatment with a gum lift and composite veneers on both arches: accepted by the patient.
  • Future porcelain and implant technology will be considered; accepted by the patient.

Procedure & Results

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The first phase was orthodontic levelling and alignment using: TAD to intrude and the procline maxillary anterior(front) teeth.

This was followed by gum lift and composite teeth veneers as per diagnostic mock up. Note her improvement in lower facial volume, lip support and jaw line.

The work was completed in 18 months using orthodontic treatment with PAOO (this is to speed up the orthodontic treatment process in reducing 50% of the time to treat) and TAD (temporary anchorage device) to intrude upper six teeth, followed by gum lift and composite veneers. It is best not to rush biology and allow optimal healing.

Final treatment outcome and we have a happy patient.

  • Note improvement in lower facial volume
  • Reduced facial folding
  • Full natural smile
  • No facial musculature exertion during smiling
  • Beautiful lips and beautiful teeth
  • Beautiful face
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As a specialist in aesthetic and reconstructive dentistry this lovely patient “the Girl from Brazil”, having been through so much in life, never failed to amaze me with her sincerity, gracefulness and patience. To “The Girl from Brazil”, I thank you for giving me the opportunity to treat you and thank you for allowing me to share your story with the world.

As a specialist in aesthetic and reconstructive dentistry this lovely patient “the Girl from Brazil”, having been through so much in life, never failed to amaze me with her sincerity, gracefulness and patience. To “The Girl from Brazil”, I thank you for giving me the opportunity to treat you and thank you for allowing me to share your story with the world.

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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