Before and After Success Stories
Challenge: Advanced wear and acid erosion involving all remaining teeth. Shifting of the remaining teeth resulted in the growth of bone that houses the teeth, subsequently when the teeth were brought together, the gums of the upper arch almost touched the lower arch. The teeth had short roots due to previous history of orthodontics.
Treatment Plan: Working with our interdisciplinary teams oral surgeon, the remaining teeth were extracted and aggressive alveoloplasty performed, followed by the placement of six dental implants on the upper arch and five dental implants on the lower arch. A removable palate-less maxillary prosthesis and a mandibular fixed hybrid were fabricated.
Challenge: Worn teeth with an edge to edge occlusion, anterior crossbite, lack of canine guidance due to early loss of #6, periodontitis and localized recession.
Team Treatment Plan: An interdisciplinary meeting with the orthodontist, periodontist and restorative dentist produced the treatment plan. Implant site development, occlusal issues, periodontal treatment, leveling and aligning the arches, as well as final restorative materials were all considered with final tooth position and sizes driving the decision making process. Treatment sequence was determined and followed over the course of 3 years.
Single Tooth Implant in an Esthetically Compromised Site
Challenge: A recurrent infection of an apicoectomy on #10 and resultant buccal fistula. The buccal cortical plate had been destroyed from both surgery and infection. There had been loss of papilla and alveolar bone height, particularly on the distal. The challenge was to rebuild what had been lost through grafting and prosthetic technique. The goal of treatment was to have dental and gingival contours that were indistinguishable from the natural teeth.
Treatment Plan: An atraumatic extraction and socket preservation with bone and soft tissue grafting. After healing a dental implant was placed with secondary soft tissue grafting. The implant was uncovered after osseointegration and immediately provisionalized to promote and support the new gingival architecture. A custom milled Zirconia abutment and crown were fabricated. Note the dental and soft tissue contours that duplicate the patient’s natural dentition and are harmonious with the patient’s function and esthetics.
Maxillary and Mandibular Anterior Teeth WearThis patient presented with wear of his maxillary and mandibular anterior teeth, primarily from acid erosion. A diagnostic wax-up was performed on mounted study casts from which provisional restorations were fabricated on teeth #’s 6-11 and 22-27. Gingival grafts were then performed on teeth #’s 5, 9, 12 and 28. After four months, final impressions were made for the definitive restorations. Once the case was inserted, a nighttime appliance was fabricated.
Maxillary and Mandibular Anterior Teeth
This patient presented with wear of his maxillary and mandibular anterior teeth, primarily from acid erosion. A diagnostic wax-up was performed on mounted study casts from which provisional restorations were fabricated on teeth #’s 6-11 and 22-27. Gingival grafts were then performed on teeth #’s 5, 9, 12 and 28. After four months, final impressions were made for the definitive restorations. Once the case was inserted, a nighttime appliance was fabricated.
Maxillary Anterior Teeth Severe Wear
This patient presented with severe wear of her maxillary anterior teeth. Orthodontics was utilized to align the gingival levels as well as to allow room for the definitive restorations. After orthodontics, bleaching was performed and teeth #’s 7-10 were prepared for porcelain veneers.
Maxillary Complete Denture
Gail presented with a maxillary complete denture. She wanted dental implants so she would not have to remove her teeth. Additionally, she desired a better smile. A new maxillary denture was fabricated, and upon delivery, the mandibular teeth were provisionalized to idealize the occlusal plane. Eight implants were placed in the maxillary arch relative to the new desired tooth position and an implant-supported prosthesis was fabricated. The mandibular definitive crowns were delivered.
Laurie presented desiring to replace her existing maxillary crowns and at the same time improve the appearance of her smile. She refused orthodontics. Crown lengthening was performed on teeth #’s 3-14, and then provisional restorations were fabricated. Definitive crowns were delivered for teeth #’s 3-14 and veneers were fabricated for teeth #’s 23-26. The rest of the teeth were bleached.
Severe Acid Erosion of Maxillary Teeth
Kathy presented with severe acid erosion of her maxillary teeth. She desired normal tooth proportions and she hated her gummy smile. Crown lengthening of all of her maxillary teeth was performed and teeth #’s 3-14 were restored. Her bite was opened to gain the restorative space in the anterior. Her mandibular teeth were bleached.
Orthodontic, Periodontal and Restorative Correction
Ann, a 64 year old female presented with worn and shifting teeth. Her desire was to have a more pleasant, full smile.
After comprehensive evaluation it was determined that orthodontic repositioning would be utilized to optimize anterior tooth proportion and periodontal crown lengthening would be used in the posterior.
The patient wore Invisalign trays to align the gingiva and optimize anterior relations. Full mouth crown extension was performed by the periodontist. Full mouth reconstruction with implant #18.
Orthodontic Correction, Single Tooth Implant
Jeanette, a 65 year old female patient of record presented with throbbing pain with draining fistula #8. CT scan showed apical resorption and palatal abscess. Understanding that an implant was recommended, we discussed her anterior esthetics. The patient expressed a desire to correct her tooth position for a more attractive presentation. It was decided to perform orthodontic repositioning prior to implant placement in order to ensure proper gingival and dental symmetry.
Once orthodontic therapy was completed, extraction, immediate implant placement and provisionalization was performed to ensure gingival contour management. After 4 months of healing, the final restoration was fabricated.
Chloe, an 18 year old female patient fell and hit her teeth on the sidewalk. Patient brought in photos of her smile for reference. A stone model was made for a wax up to construct a matrix for placing direct composites utilizing the Newton Fahl layering technique on #’s 8 and 9.
Nick, a 19 year old male, presented with microdontia and a chief complaint of limited to no display of maxillary teeth. We whitened his teeth using the Kor Whitening system and placed veneers on #’s 4-13.
Maxillary and Mandibular Fixed Hybrid Prostheses
Greg, a 25 year old male, presented with oligodontia. He was missing all but 6 permanent teeth. Decay was present on all existing teeth. Due to the congenital situation there was lack of development of the alveolar process in many areas. A maxillary provisional bridge and mandibular partial were used to test tooth position and phonetics. 3D digital scans were used to plan implants on both maxillary and mandibular arches relative to the known tooth position. CAD/CAM surgical guides were utilized for implant placement. The four first molars were retained and crowned. Six implants were placed in the maxilla and five in the mandible. We loaded provisional hybrids on the day of implant surgery.
After 4 months of healing, definitive fixed hybrid restorations were fabricated. This was a life-altering process for this young man.