Featured Case 10/20: SMILE MAKEOVER

Patient:

Alyssa, 18-year-old Female

The problem:

• Trauma to her face, lips, and jaw.
• "I want my smile back."
• Knocked out (traumatically avulsed) and loose (luxated) front teeth.
• Upper lip laceration.

Patient History:

• Alyssa was first seen as requested by her primary dentist.
• She reported being assaulted with blunt force trauma to her face and head by a known assailant.
• She was evaluated in the Emergency room and determined to have a concussion in addition to her face/oral trauma.
• Given her injury, her dentist coordinated an interdisciplinary team for comprehensive care.
• The team consisted of a cosmetic and restorative dentist, orthodontist, master ceramist and lab technician, and Oral & Maxillofacial Surgeon.

Pertinent Information

• Facial trauma and loss of teeth create multi-factorial challenges with esthetics and functional reconstruction.
• The emotional impact is devastating to patients—especially a beautiful young lady of 18 years.
• Assaults are very destabilizing to the patient's emotional health, well-being, and self-confidence.
• The primary goal is to rehabilitate her as close to their pre-traumatic condition as possible.
• She lost 2 teeth (#10 and #11) and other regional teeth in the esthetic zone were loosened and malpositioned (luxated).

Procedures & Treatment Course:

• Initial stabilization of teeth and repair of lacerations were performed.
• A temporary prosthesis was initially fabricated by her dentist to replace the missing teeth.
• She then underwent a course of orthodontics to align her teeth optimally and place them in the correct positions.
• Bone and soft tissue graft reconstruction of the missing tooth sites was performed.
• A single dental implant was placed in the #11 site.

• Periodontal plastic surgery and sculpting of the gingival soft tissue were performed surgically (connective tissue graft and gingivoplasty) as well as prosthetically.
• Temporary screw-retained (fixated to the implant) provisional teeth were utilized to develop the architecture of the tissue and smile aesthetics.
• This sculpting process was a detailed and time-consuming process to restore natural contours and aesthetics.
• Final modeling of the teeth was acquired in a completely digital process using high-definition intra-oral scanning.
• The lab technician then used this digital information to design and fabricate replacement teeth.
• Her dentist then placed the final restoration using an implant (#11) retained cantilevered bridge (pontic #10).

Commentary:

• Comprehensive dental and facial reconstruction is optimally achieved by a cohesive and well-orchestrated interdisciplinary team with excellent communication.
• Each member of the team is critical and integral to ultimate success.
• One may ask, “Why one implant for 2 teeth?” This is one case where “less is more” and when implants are too close to each other, it is biologically impossible to develop the scalloped architecture and gingival papilla.
• Extensive experience and a comprehensive skill set are critical factors to long-term success.
• In restoring Alyssa’s smile, we managed to restore the self-confidence of an amazing young entrepreneur and beautiful individual.
• We are delighted to have played a role in her care and rehabilitation.