CASE 6 “Missing teeth” (continuation of multidisciplinary case 5)

Age: 20

Sex: Female

Treatment plan: An interdisciplinary approach was selected for this patient to prevent the issues faced earlier and provide optimal care

Treatment steps: In view of the patient’s concerns and desires, a diagnostic wax-up was fabricated for her (Fig. 1.40). It helped assess and address esthetics, tooth positions, prosthetic space availability, tissue heights, implant positions, the need for grafting, and the desired occlusion [42]. A periodontal consult was sched-

The first phase of treatment included initiating conventional orthodontic treatment (Fig. 1.41). The oral surgeon and the restorative dentist monitored the progress of the treatment to provide guidance on root positioning for the implant and restorative treatment (Figs. 1.42, 1.43) [35, 36]. Once the desired prosthetic spaces were achieved through correction of the root inclinations, the final phase of the orthodontic treatment was initiated (Figs. 1.44, 1.45). At this stage, all refinements in teeth position were made. Another diagnostic wax-up was created to help visualize the final position of the prosthetic teeth. This wax-up was used to fabricate a surgical guide that directed the implant placement (Figs. 1.46, 1.47) uled to discuss correction of the gingival zeniths; however, the patient was not interested in correcting them

Keys to success: During the initial meeting with the oral surgeon and orthodontist, treatment goals were reviewed along with the diagnostic wax-up, images, and radiographs. The goal was to ensure that all the treating dental professionals would visualize the same endpoint and work in a structured and collaborative manner.

The implants were placed by the surgeon using the surgical guide [43]. Following 6 months to allow integration, the implants were uncovered, and restorative procedures were initiated. Implant abutments were tried in the patient’s mouth to verify fit, occlusal clearance, and symmetry (Fig. 1.48), followed by fabrication and placement of implant restorations in the patient’s mouth. The laboratory was instructed to fabricate another wax-up on the casts to idealize tooth proportions (Fig. 1.49). The wax-up was used to guide the placement of direct restorations on the natural teeth. The final restorations were a combination of composite and porcelain restorations (Figs. 1.50, 1.51)

Treatment considerations: Several factors, including the type of prosthesis, esthetic desires, oral hygiene, periodontal condition, quantity and quality of bone, the position of teeth and roots, and finances, must be taken into consideration to achieve a predictable treatment result [30, 34-41]. The restorative dentist is the architect of the treatment plan [15]. It is paramount that the restorative dentist constantly communicate with the other specialists and regularly monitor the patient to ensure that the treatment proceeds as planned [15]