Paul D., is a 56 year old male, sales executive for a large multi-national well known optics company. The firm fabricates optical machines which are used in healthcare both for clinical and research purposes. He often makes presentations to small as well as large groups. Personal appearance as well as speaking ability is very important. So when he presented to our office with his desire to “makeover” his smile, it was important that whatever physical improvements and changes that might be made, they could not interfere with his functional speaking ability.
In his youth Paul D., was very active; he participated in many sports. Physically, he absorbed some significant “hits” during these contact sports activities in which he was engaged. Besides the worn physical appearance of his dentition secondary to his sports activities, it was felt that the patient also would clench and grind is his teeth. His dentition suffered as a result. The images below reflect his dentition at his initial presentation.
Our approach is the same as all previously reported cases. After gathering all our clinical data, and having taken the necessary x-ray films, ral photography, diagnostic impressions were taken for study models. The models were then sent to the laboratory for a wax “mock-up” version of what the final case would look like. However, this time the waxing process was completed by CAD-CAM, which stands for “Computer Aided Design-Computer Aided Manufacture”. The images below represent the wax-up version.
The wax-up models were then shown to the patient. He liked the size and shape of the teeth very much and wanted to proceed. From the models it is apparent, however, that in order to make the teeth longer in appearance, the patient would have to undergo “Periodontal Plastic Surgery” to reshape the periodontal soft tissues and give the teeth a longer profile.
With that said, however, preliminarily the third molars were extracted and after sufficient healing the teeth were bleached using an in-office “Zoom Bleaching” Procedure. This is the same technique used on the ABC Television show ‘Extreme Makeover”. With the initial phase completed, the patient then underwent Periodontal Plastic Surgery, which lengthened the teeth . After sufficient healing the teeth were then prepared for Porcelain Jackets. Using the the wax-up version, a matrix was fabricated and the matrix was then used to fabricate the temporary restorations. Beneath this paragraph the upper image is that of the initial temporary restoration in place. Wearing the temporary restoration, the patient encountered difficulty phonetically forming his words. With that said, the temporary restoration was adjusted by shortening the length of the temporary teeth. The patient was then able to speak without difficulty and phonetically sound out his words without hindrance. An impression was taken intraorally of the adjusted temporary restoration that the patient liked and functioned well. The model retrieved from the impression was then sent to the laboratory. The model was scanned in the laboratory by computer and the parameters of size, width and length of teeth were incorporated into the computer fabricated Porcelain Jacket Crowns. The lower image is that of the adjusted temporary restoration.
Images of the completed case are found below. Prior to the completion of care an Occlusal Guard was fabricated to protect his dentition and the new restorations.
If you would like to discuss this case presented or any other case previously presented in this blog please feel free to contact Dr.Mitchell Indictor, at eastboyntondental.com. He would be glad to speak with you.