How to create the perfect smile

Dear collegues
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!

29.10.2015, 13:11
Dear colleagues. Thank you very much for your interesting thoughts on this case. We now decided to go for monolythic lithium-disilicate in the posterior sections and feldspathic in the anterior. I absolutely agree, that there is a risk of fractures and chippings. The patient received a michigan splint for prevention. I'll try to kkep you updated.
15.04.2016, 11:53
It looks like there are a number of issues you are going to have to deal with and patient expectations may have to be altered due to the existing conditions. The periodontal status looks to be guarded long term and the crown/root ratios unfavourable. There is some significant wear on the anterior teeth as seen in the occlusal view and abfractions and recession along the buccal corridors.

If you do decide to go the route of full mouth reconstruction with Crowns and Veneers there is a much higher risk of porcelain fractures in patients such as this. The patient seems to have a low smile line which hides much of the root recession and the abfractions. If you try to bond to these areas with your porcelains you are not going to get very strong bonds and again, based on the history of wear shown, you may get fractures in your porcelain work.

I think that if the patient is looking for an aesthetic option and accepts the fact that the long term prognosis is guarded with these teeth then your treatment plan should provide a nice aesthetic outcome and the patient will be happy. Just be sure they understand the longer term risks so they don't come back when things break down and blame you for the work.

I think these are tough situations because we want to, of course, save teeth, but we are challenged to keep things looking good when the foundation is so compromised. This would be a great case to follow long term. hope you can keep us up to date on how it all goes.
14.04.2016, 21:32
Thank you both for your answers! For me the minimal-invasive approach of Mr. Sapata would be the best solution as well. The patients budget seems to be high enough for the full-mouth rehabilitation. Have a look at our mock-up and thank you for your further comments...
17.12.2015, 20:29
In my opinion, after a wax-up planning, you can improve the aesthetics and function using:
1º, 3º, 4º and 6º sextants - crowns (e.max or PFM)
2º and 5º sextants - porcelain or composite resin veneers (according to the budget)
19.11.2015, 10:01
Full arch bridge for all teeth in the maxillary arch is an excellent solution in these cases
09.11.2015, 00:18