This patient entered our clinic with a wish for a better smile. The orthodontists refuse to treat him because of the short roots and the huge discrepancies of the jaws. The patient refuses to get a maxillofacial surgery.
How can I fulfill his wish? Thanks for your help!
I would like to share with you a clinical situation and know your thoughts about the possible etiology of the problem.
Mr. X attended my office 5 years ago with a partial edentulism in position 26 and 46.
He suffers from Behcet syndrome, disease that involves inflammation of the blood vessels and which causes sporadic sores in mouth and sex organs and caused his blindness 20 years ago.
He is a friend of the family and asked me to replace these posterior teeth.
He also suffers from bruxism, evidenced by a generalized moderate tooth wear and generalized exostosis of the alveolar bones.
I planned and placed two single implants (Straumann Bone Level, Regular platform) in the free-end positions 26 and 46.
Last week he called complaining of movement on the screw-retained crown on implant 46.
Today, I removed the crown and after retightening it again I realized the implant was slightly painful and mobile. Probing after crown removal was normal. No suppuration was present. Just the normal irritation of the marginal mucosa compatible with the movable crown.
This is the periapical x-ray I took.
Since he was in a hurry, I decided to place a healing cap on the implant and control his evolution in 2 weeks.
What do you think the etiology of the problem could be? Could the occlusal overload have broken the osseointegration of an implant that has been in function and stable for 5 years?
The implant in position 26 is asymptomatic and in function.
I will highly appreciate to hear your comments in such a controversial topic.
I would like to share another case with you. I have to prosthetically reconstruct a 58 year old female patient. Due to a root fracture she lost the abutment tooth 13 supporting a 6-unit FDP (13-x-x-x-x-23). Subsequently, 3 implants were place in guided implant surgery in the following sites: 13/11/21. All of the implants are two-piece implants with a 4.1 mm diameter and an internal connection (Straumann BL RC). I want to provide the patient a reconstruction that guarantees both mechanical stability but also maximal esthetics and a good cleanability.
How would you prosthetic treatment plan look like? What kind of prosthetic reconstruction would you chose? Would you segment the reconstruction? If yes, how many segments would you prefer?
Please explain me your thoughts.
Thank you very much.
In a case like that where we have:
- Asymetrical Marginal position of 11# / 21 due to Vertical resorption following extraction (#11/12) whereas remaining teeth (21#/23) area maintain both hard and soft tissue would you rather compensate vertical resorption (following extraction) on the esthetic right side
What treatment suggestion would you recommend:
1. using pink porcelain
2. Crown lengthening of 21 and 23
3. Connective tissue graft
4. other suggestions
This patient consulted to ameliorate her smile. SHe is extremely anxious at the simple idea of a dental appointment and wants the simplest and minimal invasive treatment possible. In particular, she is not interested in orthognatic surgery or orthodontic treatment. She is mainly asking new crowns on the laterals and less pointy canines. How would you manage the gummy smile and disharmonious gum line? And what are your consideration regarding the cross bite?
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