After a traumatic facial injury, patients are often able to regain esthetic confidence through reconstructive surgery. These expectations can be brought into the dentist office as well, with little understanding to the complexity of dental reconstruction. Dr. Jose-Luis Ruiz keeps this in mind when compiling a reconstructive treatment plan, being sure that the patient is aware of the degree of difficulty for their case.
In this case report, Dr. Ruiz reached optimal results through conscientious discussing, planning and use of a new all-ceramic fixed partial denture.
The patient had severe facial injury from a car accident causing her to lose several anterior teeth. Three years prior to the accident, she had begun treatment to replace her anterior teeth but was unhappy with the orthodontic results. She felt her smile was crooked and desired to have a beautiful and natural-looking smile. Dr. Ruiz was aware that the patient’s expectations were high and was very clear in discussing the options and bringing cautions to her attention.
In evaluating the patient and planning the treatment, factors affecting the doctor’s path were items such as severity of ridge loss, tooth position, level of gingival display when patient smiles, patient’s financial situation and age. In light of these factors as well as input from the patient, Dr. Ruiz chose the following multidisciplinary treatment plan.
Treatment Plan:
Orthodontic treatment for occlusal cant and midline, ridge-augmentation surgery, ovate pontics on all-ceramic fixed partial denture
Procedure
Phase One: Orthodontics
• Adjust midline closer to center
• Diminish occlusal cant
Phase Two
• Create mounted models
• Create ideal wax-up
• Make one set of acrylic provisionals with ovate pontics
• Prepare teeth for porcelain crowns
–> 2mm occlusal reduction
–> 1.5 mm axial reduction
–> round angles
–> butt cavosurface margin
Phase Three: Periodontist
• Ridge-augmentation surgery
–> Provisional showed how much tissue would be needed
• Impressions taken (after 8 weeks of healing)
• Cement bridge and crowns
Dr. Ruiz’s patient was extremely happy with the results. This satisfaction was due to emotional management and proper communication about realistic expectations for the procedure as well as excellent collaboration between the members of the esthetic dental team.
Click here to Read the Original Article in the Journal of Esthetic and Restorative Dentistry