Case Study - Trauma and oral rehabilitation

When this beautiful triathlete presented in my surgery flying directly from Japan for reconstitution of the missing dental segments and teeth, I knew we had a considerable challenge ahead. Why?
Because the degree of tissue laceration, teeth intrusion, damaged soft and hard tissues, high smile line and most importantly the fact that the patient is professional and triathlete and was disrupted from rigorous training.

Patient with provisional splinted teeth as an emergency measure.  Photos very kindly provided by her dentist in Japan.
Patient presented with complex tooth and root fractures as a result of triathlon bicycle accident:  affecting anterior teeth (fractured 12,11,21,32,31, & 41). These teeth were splinted in UK and removed by her dentist in Japan.



These are the original images provided by her dentist in Japan.








In many ways these images provide us with the best guide for reconstructive procedures









Examination shows good soft tissue regeneration. Moderate to high smile line, normal range of craniomandibular and general periodontal (gum) stability.





Note the presence of soft and hard issue defects. We need to rebuild these tissue defects to restore anatomy and reconstruct this lovely patient’s smile and function. Patient also had important private engagements, therefore immediate establishment of function and aesthetics was essential. I sincerely feel we have achieved an optimal result.



Complex crown fractures of 12,11,41,31 & 32-dentine exposure
Gum laceration 12
11 is fractured and displaced coronally.

  1. Degree of tissue loss hard and soft
  2. Healing stage post trauma
  3. Biotype

Assess with lips in position

  1. Degree of tissue loss hard and soft
  2. Healing stage post trauma







I also feel the possibility of grafting 11 in the future to provide a buccal/labial balcony would help to keep the tissues in a better position in this critical aesthetic zone. It is difficult to say how successful we will be, but it should be carried out to improve all chances of tissue preservation and regeneration.
Initial reconstructive procedure:  stabilising the bite and improving immediate aesthetics and confidence.

Note the degree of aesthetic reconstruction, which was achieved in one visit: technique especially developed by Dr Nalbandian. The missing tooth site was restored using composite FRC technology (fibre-bond resin construction technology).  The guide provided by the original photo images was gold and we are very grateful to the referring dentist. This procedure was achieved with zero tooth invasion and in one visit!
The missing tooth site was grafted and allowed to heal for 6 months
Immediate aesthetics and function.









Imitating nature is called mimesis by Aristotle.
















Immediate improved confidence using composite reconstructions.




Once the tissues were healed, we proceeded with implant placement and final implant supported crown constructions.
We placed porcelain veneer on tooth 11 and implant supported crown on abutment at site 21.
I also emphasised the problems with gum aesthetics around the implant and that the patient reveals the gums slightly when smiling. Due to presence of thin tissues and possible bone loss from past infection, there may be some compromise as we will not be able to obtain a completely natural look, with the consideration of pink porcelain around the margins of the final crown. The idea is to generate an excess gum tissue for better maintenance and preservation of gum aesthetics. I may also elect to consider a connective tissue graft to thicken the tissues as well.

Matching the porcelain veneer on tooth 11 with implant supported crown on 21.
Note the well integrated implant with the bone and optimal bone regeneration.



One Smile says it all!

I sincerely believe that we have achieved the desired functional and aesthetic reconstructions to complement this beautiful triathlete.
All above procedures were performed by Dr Sarkis Nalbandian.
Education and Experience are everything.
Designer Smiles® is a one stop shop for most implant, surgical and reconstructive (prosthodontic) oral rehabilitation solutions.



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