This case is about a full mouth rehabilitation on a limited budget using long term interim restorations. The patient has failed aesthetics: failing crowns and bridgework affecting patients comfort, function and aesthetics. This is further compounded by the presence of high smile line and reverse smile line created by abnormal tooth wear from loss of posterior (back teeth) support and bruxing (grinding teeth together during the night and or day time). Naturally dietary influence of tooth surface loss has been accounted with this patient.
You will notice the poor adaptation of upper and lower removable dentures, fractured teeth and failing restorations that were all present in this patient’s mouth. The sharp teeth were most uncomfortable for her. She had uneven tooth wear on both arches. The excessive teeth wear and loss of lower facial height (we refer to this as reduced occlusal vertical dimension) that must be restored to allow correct tooth anatomy, arch level and position development and restore normal speech as this lovely patient’s speech was also affected by having short and sharp teeth.
The treatment I administered was the reconstruction of maxilla (upper arch) and mandible using tooth supported direct composite restorations bonded to existing teeth. The patient’s own removable partial dentures were modified and refitted.
This study will show:
The patient was referred by her sister, an existing patient of mine, seeking a specialist dentist’s opinion and treatment in relation to fixed option of restoring worn, missing teeth and failing restorations (dental fillings).
The loss of back teeth initially replaced with partial dentures were inadequate, providing no support and in many ways contributing to accelerated wear of maxillary (upper) front teeth with dire aesthetic and functional consequences. You will note that the porcelain crown on upper lateral incisor is not affected, while the remainder of dentition are highly affected. This dissimilar wear will eventually exert critical force to fracture tooth 12 with past root canal therapy causing eventual loss of tooth 12 and further wear, eventually rendering her entire dentition to costly for full mouth crowns and bridgework rehabilitation.
Composite reconstructions were chosen for the following reasons:
The patient’s main concerns were: she wanted to be able chew her food and smile confidently showing her teeth, improve the aesthetic appearance of her smile, and a fresher look. The concern was to improve the upper arch shape and smile line as well as tooth colour.
My diagnosis was: Unacceptable TSL (tooth suurface loss), dental aesthetics and function and dissatisfaction with failing restorations causing functional and aesthetic disturbance.
My aim was to restore her lower facial height and restore speech. Furthermore, in this process, to improve the aesthetics of upper and lower teeth arches: tooth shape, display, teeth colour, length, and symmetry and smile line in general reconstructing teeth with tooth surface loss.
This was accomplished with minimal discomfort to the patient and her procedure was completed in one long visit, a One Visit Smile Lift™.
I discussed all the risks and treatment modalities with the patient that included:
The work was completed in one visit. Naturally we carried out a diagnostic mock up in the mouth to assess the aesthetics and speech that the patient was happy with.
Followed by completing the diagnostic wax up in the laboratory as a part of the assessment of the amount of bite opening required. This was transferred into the mouth and both jaws were restored to correct facial height. All in one long appointment.
Dentistry changes lives of all ages. All we want is youthfulness. The patient is happy now. She can eat comfortably and smile with confidence.I t was a pleasure to treat her.
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