Dental Facelift: Rebuilding a Smile After 20 Years of Bridgework
Failed aesthetics
Failing veneers, crowns and bridgework affecting patients’ comfort, function, and aesthetics. This is further compounded by dark spaces in the lower arch and asymmetric lower-lip deflection.
Treatment: reconstruction of maxilla (upper arch) and mandible (lower arch) using tooth-supported veneers, crowns, and bridgework.
This study will show
- Complexity of treatment
- Treatment outcome
- Patient’s assessment
- Please refer to the video provided
- Discoloured lower porcelain veneers and dark triangles.
- There is lack of symmetry and harmony.
- The porcelain veneers have been recemented number of times.
- Reduced upper lip support
- The existing restorations have been in place for some time. However, patient works in a corporate world, and felt it was time to rejuvenate her smile as it affected her confidence.
Dark spaces as edentulous ridges have undergone resorption over time: causing food impaction
The existing restorations have been repaired subsequently.
Porcelain veneers have been recemented number of times
Chief concerns: improving the aesthetic appearance of her smile. The concern is to improve the upper arch shape, smile line, and tooth colour. This lovely patient wants to smile with confidence.
Initial Presentation
Patient was referred by her dentist for a specialist’s opinion and treatment regarding fixed restorations for missing teeth and failing dentition, as well as tooth-supported crowns. The loss of teeth from failing bridgework has left considerable soft- and hard-tissue defects that require augmentation to create a base for tooth replacement. Since the existing design of the crowns and bridgework has served well for the last 20 years, we decided to replace the restorations and improve the design, using only tooth-supported bridgework, as there was no need to complicate the treatment or increase costs with dental implants.
We have unacceptable aesthetics.
In general, whenever possible, we would like to replace, or at least approach, the foundation bone and gum tissues to allow optimal tooth position in the arch that creates a natural aesthetic.
Diagnosis:
Unacceptable dental aesthetics due to dissatisfaction with failing fixed restorations and general tooth discolouration
Our Aim: to improve the aesthetics of both arches: tooth shape, display, tooth colour, length, symmetry, and smile line in general, replacing existing veneers and crowns with new porcelain technology.
This was accomplished with minimal discomfort to the patient and MS M. Never left the practice without missing teeth. The provisional restorations constructed were instrumental in the final aesthetic and functional outcome.
Treatment
Following the discussion of all risks and treatment modalities with our patient that included
No treatment: this is not an option as the restorations are failing and affecting the longevity of supporting teeth
Repair existing restorations and make a removable partial denture: this is a temporary measure and not accepted by the patient
Fixed option: tooth-supported crowns and bridgework, described below
Removal of failing bridgeworks
Placement of provisional crowns and bridgework
Finalise the treatment with tooth-supported porcelain veneers. Crowns and bridgework in the upper arch. The Provisional restorations provided important confidence for normative function, comfort & aesthetics.
Procedure & Results
The work was completed in two months
Provisional restorations MS M approving the colour and shape
Note improvement in smile line, lip outline, support & thickness
Final treatment outcome: we have restored aesthetics, comfort & function, and we have a happy patient
Note improvement in lip thickness & support
Final treatment outcome: we have restored aesthetics, comfort & function.
Final treatment outcome, and we have a confident and happy patient.
Registered Specialist
Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)
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