Driving Restorative Outcomes in Multi-Disciplinary Cases : A Case Study by Kevin Low
Case Background
The importance of assembling a multi-disciplinary team that is in alignment with your values, treatment philosophy and shares your level of aesthetic demand, is crucial. It is never more clear, when you are dealing with a pre-teen patient and their parents.
When restorative is the final phase and you are responsible for the final outcome, ensuring that you quarterback the entire treatment plan is imperative. You also need a team that is willing to collaborate and take the time to plan with the end in mind. Tyler and I spent countless hours over this the last 9 years to ensure that we could adequately accomplish the goals stated.
Multi-Phase Planning
This sweet 10 year old presented with congenitally missing laterals but the complications also included Multi-Phase Planning with orthodontist Dr Tyler Pritchard. This 9 year project included:
- Transpose #10 and 9 through Phase II ortho
- Palatal expansion to improve buccal corridor
- Orthodontically intrude for Class I Occlusion
Through consultation with parents, it was important to manage expectations for length of treatment and consistently stay connected through phases to provide provisional and tissue modeling support. The parent’s long term choice included future implants in the #7 and #10 sites.
After ortho, patient presented with the following :
- Gummy Smile
- Wear patterns
- Group function on patients right side
- Tooth size – arch length discrepancy
- Patient unhappy with color of teeth
- Fluorosis
These issues required careful planning to address functional concerns while achieving the desired aesthetic outcome.
Tissue and Prosthetic Preparation
The next phase focused on creating an ideal emergence profile for prosthetics. This involved:
- Addressing aesthetic tissue concerns with gingivectomy and crown lengthening where necessary.
- Creating ovate pontics to enhance the emergence of prosthetics.
- Fitting the patient with long-term provisionals to model tissue before implant placement.
Provisionals were fabricated using a custom impression coping technique, leveraging the expertise of Gold Dust Dental Lab and techniques taught in our Anterior Aesthetic Live course in Dallas, TX.
Final Restoration
To address the color and shape discrepancies of the teeth, the patient and parents agreed to eight minimally invasive porcelain veneers. These veneers were designed to:
- Broaden the buccal corridor.
- Correct tooth color.
- Enhance the overall aesthetic outcome.
Outcome
The final result was a beautiful, functional smile that delighted the patient, parents, and our team. This case highlights the importance of thorough planning and collaboration with professionals who share a commitment to exceptional patient care. Achieving such outcomes requires not only technical skill but also a shared dedication to the patient’s long-term well-being and satisfaction.
