Diagnostics and treatment planning

TABREZ LAKHA 24/08/2016, 07:16 PM


Dear colleagues,
Mr. X entered our clinic with a history of trauma in the region of 11 and 12.The following was observed:

Intra oral examination :

Soft tissue examination: laceration was evident in the region of 11 .

On clinical examination mobility was noted with the crown structure of 11 and 12.

Radiographic examination:

CBCT was done, fracture at the CEJ was noted.


Treatment done so far:
1.Extraction of crowns
2.Pulp extirpation
3. Sealing of roots
4.Conective Graft obtained
5.Graft sutured
6. RPD fabrication

Patients desires a Fixed restoration.

What would you suggest amongst the following probable plans?

1. Extraction of 11 , immediate implant placement and a cantilevered restoration (tooth 12 left buried in situ to maintain hard and soft tissue profile)

2. Extraction of both teeth and immediate implants and immediate provisonalisation followed by definitive restoration.

3. Use of socket shield technique to insert implants in 11 and 12 regions followed by definitive restoration

4.Extraction of both teeth and implant placement using a delayed protocol(type 2 or type 3)

Alexis Ioannidis 09/07/2016, 07:09 PM

Immediate implant placement or conservative procedure?

Dear colleagues

Is this an ideal case to perform an immediate implant placement or would you prefer a more conservative procedure? What are the decision criteria?

Br, Alexis

Marco Zeltner 24/06/2016, 05:42 PM

How to solve this case

Hi friends

i want to share another case with you.

A 45 year old female patient wants to improve her smile. She has crowding in the upper anterior area and loss of tooth substance on the palatal aspect of the anterior teeth. She is not willing to move her teeth by means of a fixed or visible orthodontic device.

Any ideas, how to proceed. The patient is very impatient and demanding.

Thank you for your inputs


Barbara Martina Eisner 23/05/2016, 07:58 AM

Heavy biter

Dear colleagues
I would like to share this new case with you. The 47 year old patient showed up in our clinic, because he was no longer happy with his dental appearance. As you can easily see, the patient is a heavy biter and has lost already a lot of his vertical dimension. His primary wish is to get an esthetic improvement especially in the upper jaw and secondary a better chewing ability. I would like to provide the patient a reconstruction that guarantees both, mechanical stability and maximal esthetics. How would your treatment plan look like? What kind of material would you choose?
Please explain me your thoughts.
Thank you very much,

Alexis Ioannidis 14/01/2016, 01:38 PM

Pronounced midline shift and loss of teeth 11,12 due to accident

Dear colleagues

I would like to share this case with you in order to receive some feedback.
This 28 year old patient has lost his right central and lateral incisors due to an accident.
His midline shows a remarkable shift of about 4mm.
What would be your treatment plan?
Thank you very much for your feedback.
Kind regards

Adrian Boesch 19/11/2015, 10:16 AM

Ankylosed tooth 21 (after severe trauma)

Dear colleagues

a 24 year old patient wants to replace his ankylosed tooth 21, because he is unhappy with his smile. Teeth 11 and 21 are provisionally restored with resin fillings. After orthodontic treatment the patient has still an open bite. The whole treatment is covered by his insurance.

I would appreciate if you look at the pictures and let me know your thoughts about the treatment planning.

Best regards


Taty Li 18/10/2015, 06:18 AM

Looking for a speciaist and clinic

Hello dear doctors!
I m looking for a clinic and specialist who will help me in my case.

Mühlemann Sven 17/09/2015, 03:24 PM

Peri-implantitis in the esthetic area

Dear colleagues

I would like to share a case with you. This young male patient got an implant in area 11 seven years ago. The clinical and radiographic examination showed a progressive bone loss around the implant and an inflamed peri-implant mucosa. I'm afraid to loose a lot of tissue, if I'm going to remove the implant.

Would you keep it? And what would be your treatment plan?

Thank very much for all your comments

Best regards


Marco Zeltner 26/08/2015, 08:24 AM

Gummy smile, missing anterior teeth

Dear colleagues,

I have another case to share with you: this 38-years old patients wants a functional and esthetic rehabilitation with a fixed reconstruction. In addition her wish is to improve the smile line. At the moment she is afraid of laughing because of her gummy smile and the visible provisional. If possible, the fixed reconstruction should be fabricated without the use of pink ceramics. She has saved 20'000 euros for the dental treatment.

As you can see on the pictures there is a lack of tissue in the anterior edentulous space. I think that a primary bone augmentation is necessary to fulfill all her desires. In addition some of the posterior teeth may need crown lengthening to defuse the gummy smile. How would you proceed with this case?

Thank you very much for all your inputs

Best regards


Marco Zeltner 15/04/2015, 11:22 AM

Esthetic improvement

Dear colleagues

I would like to share a case with you that is of particular importance for me, since the patient is a really close friend. The patient had multiple prosthetic treatments in the upper anterior region after having had two or three accidents (he is an ice hockey player). At the moment, the upper front is reconstructed with three tooth supported PFM crowns (11, 12, 22) and an implant-supported screw-retained PFM crown (21). Understandably he is very unhappy with his smile. By the end of September he is going to be married and he wants to change his appearance before that.
My goal is to esthetically improve the situation without any complication. What kind of treatment would propose to predictably achieve this goal?

Thank you so much for your comments....


Jose Reuss 27/10/2014, 11:39 PM

Full mouth complex planning

Dear Colleagues,

I would like to share another case with you. This patient is a 56 y.o. woman, non-smoker and ASA I. She came to our office because of 'tooth mobility' and 'pain on multiple teeth when biting'. All teeth except for the upper and lower canines presented at least class II mobility. The canines had + / 1 mobility. She was classified as having a generalized severe chronic periodontitis, presenting suppuration on teeth # 14, 11, 21, 22, 24, 34, 44, 45. She had pain at percussion on teeth # 21, 24, 25, 34, 44. She was very anxious and had rejected dental treatment for many years, but her situation lately was 'too uncomfortable'.
Here are some pictures including a virtual tooth set-up. The smile line is noticeably high. Note the marked mandibular deviation to the right. Being aware of the hopeless situation of her teeth, the patient commented on the will to go through 'guided dental treatment', referring to guided implant surgery, if necessary.
I would appreciate to have your opinion on the treatment plan for this patient.
I thank you greatly in advance for your consideration.
Best regards,


Sary Borzangy 03/07/2013, 04:11 AM

Deep restoration

This patient has deep temporary restoration on tooth #37 OD done by a per-doctoral student and he wants to have a final restoration done. Tooth # 38 has broken amalgam restoration. He has severe bone loss due to chronic periodontitis which is maintained now. What is your treatment plan for this case keeping in mind the current periodontal condition and difficult access to the area?

Thao Le 07/06/2013, 11:03 PM

Loss of Interdental Papilla

This patient initially presented with tooth 21 with a horizontal root fracture. Tooth was extracted and delayed placement protocol was followed. Full thickness flap elevation, Bio-Oss and Bio-Gide double membrane technique was followed as described by Buser. Tooth currently has a temporary, but unesthetic black traingle that developed due to a compromised papilla. Soft tissue condition was completed to "push" papilla interdental, but outcome not as expected. Planned technique to correct this deficiency is to create longer contact and square like shaped teeth 11 and 12. What does everyone think? Thanks!

Manuel Sancho-Puchades 23/05/2013, 02:47 PM

Titanium overdose

I wanted to share with you a case that was recently referred to our department.
Patient unsatisfied with the function and esthetics of a fixed implant rehabilitation of 8 implants to replace 8 teeth.
The patient is wishing to have the rehabilitation repeated in a more satisfactory manner.
Patient brings master model with implant replicas where implant axis can be observed.
Possible treatment plan sequence:
- Preparation of two screwed 4-unit provisional FDP (12-22 and 24 to 26 with mesial extension 23) using the master model.
- Removal of current unsatisfactory restoration and placement of screwed provisional.
- Try to submerge implants 11,21,23,25
- Final aim: two cemented 4-unit provisional FDP (12-22 and 24 to 26 with mesial extension 23) on zirconia individualized abutments
I would love to hear the thoughts of the experts.
Thank you very much for your help.

Manuel Sancho-Puchades 12/05/2013, 09:19 AM

Vestibuloplasty in esthetic zone

Dear all,
Does somebody have experience in solving this kind of problem? In summary, a connective tissue graft was performed in region 22 where an implant had been placed. The graft became infected and the inflammatory process that lasted 2 weeks ended up with the result you see in the picture: loss of attached tissue and a mobile integrated graft on the buccal aspect. Lucky enough the papillae were maintained and there is keratinized tissue on the alveolar ridge. We are thinking of doing an apically positioned flap to move the movable mucosa apically and reposition the mucogingival line apically. The questions are: 1. Could we use a Mucograft to cover the exposed area?, 2. Will the procedure result in an acceptable esthetic result or will there be lots of scarring? Any input will be welcome. Thanks.

Francine Lustenberger 14/11/2012, 12:26 PM

multiple Nichtanlagen/ Sanierung

Habe eine Frage betreffend des Behandlungsplans dieser 21 jährigen Patientin. Sie leidet an multiplen Zahnretentionen. Anschlingungen haben leider keinen Erfolg gebracht. Nun wurde entschieden die retinierten Zähne im Seitenzahngebiet zu extrahieren und Implantate Regio 13 /15/ 23 /25/34/45/33/35/36 zu setzen. Würdet ihr alle retinierten Zähne extrahieren oder nur diejenigen die bei der Implantation im Wege sein könnten? Gewisse Zähne haben eine sehr nahe Lage zum N. alveolaris inferior. Habe bezüglich eines radikalen Vorgehens etwas bedenken....