Treatment Process
This patient presents in his late 50’s. He states that he knows that he needs some major dental work. He is aware of missing teeth and a tooth grinding habit. He also has a wisdom tooth that is starting to bother him.
Esthetic evaluation reveals no tooth display with the lip in a resting position, or in full smile, indicating a major esthetic imbalance.
Comprehensive examination reveals, failed restorations and root canals, decay, moderate tooth wear, missing teeth, and bite collapse. Additionally the lower right wisdom tooth has a dying nerve which has caused a toothache.
Close evaluation and exploration of several of the teeth with failed restorations and root canals, reveals major structural and biologic instability. Because heroic measures would be required to restore these teeth, and the long term prognosis would be fair at best, extraction and replacement with dental implants was elected for them. Implants were also placed in the segments where teeth were missing. The rest of the teeth required restoration with crowns for structural, functional, and esthetic reasons. In doing this, the patient’s bite was also restored to the ideal position after having been collapsed. The lower 4 front teeth were minimally damaged and could be built up to restore the bite utilizing tooth colored composite resin material.
Because the patient’s esthetics were so compromised due to the front teeth being shorted from the years of tooth wear, a diagnostic “mock-up” was made out of plastic before any treatment was provided. This gives the patient and dentist an idea of what the final esthetics of the front teeth may look like.
Temporary crowns in place. The temporaries are a very important step in the treatment as they communicate important information to the dental laboratory such as the desired tooth length and position.
Final crowns and composite veneers (lower front 4 teeth) in place. The veneers would ideally be done with porcelain for the best long term stability and esthetics. Composite resin was used in this case for financial reasons for the short term, and will likely require replacement with porcelain veneers in the future.
