Patient 4 is a 55-year-old female seeking improvement of the aesthetics of her upper teeth. A facial analysis found excessive soft tissue display, loss of anatomical form due to tooth wear and restorations, and a deep bite. X-rays showed crowding, malpositioned teeth, and a malpositioned implant. The treatment plan involves hard and soft tissue grafts, provisional restorations, and ceramic restorations to restore anatomy and satisfy aesthetic concerns with a long-term strategy.
17. patient visits a oral
hygienist 2-3 times a year
and oral hygiene is at a
good level, no abnormal
probing depths
18. deep bite due to dento alveolar eruption of
lower anterior teeth due to restorations of the
anterior teeth
diagnosis
crowding lower anterior teeth and malposition
23 and 24 (25 not present)
mal-positioned implant 22
soft tissue deficiency siebert class III 22 and
siebert class I 12
dento-alveaolar eruption premolars upper jaw
los of anatomical form due to restorations:
16,15,14,26,27 34-37 and 44-47
wear lower anterior teeth (attrittion)
19. what are the patient’s financial constraints?
how could we satisfy the patient’s aesthetic?
how to treat the hard and soft tissue
deficiencies in the aesthetic zone
Is the patient willing to go through orthodontic
and surgical procedures surgery
can we restore this patient predictably with
long-term strategy?
primary concerns
what to do with the implant at the 22
20. improve hard and soft tissue
volume at the 12 and 22
restore anatomy of the teeth
satisfy aesthetic concerns
develop long term-strategy
treatment objectives
create a stable occlusion with
anterior guidance
21. treatment plan
wax-up
hard and soft tissue graft 22
provisional restoration 21=22=23
connective tissue graft pontic site 22
copy provisionals to ceramic restoration
soft tissue healing and maturation
contouring soft tissue through
provisional restoration
prep teeth for restorations (16-27 and 33-37,43-47)
and open vdo in provisional restoration phase and
recontour lower anterior
(patients doesn’t want ortho)
evaluate biology, function and aesthetics
3 months