Correct Diagnosis is very Important !!

This young man has a history of trauma due to which his left central incisor was extracted . The bridge from right central incisor to left lateral incisor was fabricated and cemented in the U.S. There were three attempts at the same by dentists in the States since every few days the prosthesis used to get dislodged  .The cause of the same was not diagnosed by them.

 

He visited me at my office and at his first consultation I took photographs and impressions to make study models.Fremitus test was done to check trauma from occlusion also the misalignment of the lower incisors was considered.On removal of the bridge bone loss in the pontic area was noticed with midline shift and canting.Keeping all these diagnosis in mind the best treatment plan for him was designed.

 

Treatment plan:The fremitus was corrected ,incisal edges and body of the lower anterior teeth were adjusted to achieve an overjet and overbite of 1.5 mm with the present situation of existing FPD.Four laminates of emax were cemented on the mandibular incisors.A bridge was fabricated in metal free empress emax with an ovate pontic after rest seat preparation to achieve natural and esthetic papilla and emergence profile.

 

This case was done 2 and half years back and is still going strong. I am happy to have restored this handsome boys smile justifying dentofacial aesthetics.

 

 

https://www.facebook.com/DrLele.SmilesForever

 

Soft but perfect smile

Pretty faced Apoorva landed at our office for Quick fix smile! The demand of the role was a ‘soft but perfect smile ‘in addition to pretty face and acting as well!

The task for us was as under

Imagie 1

·         Remove the overlap of two centrals and align the right central. ( see image 01.)

·         Take the right canine palatally till it almost matches contra lateral canine inclination.

·         After the centrals, it was major concern for the left lateral, as I wanted to incline it mesially at the same time wanted to maintain “face of the tooth “unaltered.

·         The right lateral needed a little body to match the contralateral.

 After taking couple of snaps of smile, full face and intercuspal teeth position, I made impressions for study model. The director of the this serial wanted me to fix Apoorva’s smile in two days ( 48 hours!!)due to delay in shoot!!

I took the challenge and called her the next day to fix the desired effect.

On the day of photography and study model,  me and my associates worked on study models for virtual mock up in composites. My wife sushama made digital mockup for Apoorva's smile.

And we were all set to fix Apoorva’s smile, the next day!!

I started with two centrals by keeping the silicon key (made on study model) in the anterior area from palatal side. It took me two hours to get central in alignment.

Then it was the turn for right canine. To get the best result, always start preparing the labial surface to your desired location as per digital imaging and mock up (does not matter even if it exposes the pulp chambers while doing so!) 

In Apoorva’s case pulp exposure was very much expected beyond doubt. But trust me, as the canine had enough labial width before I could land into pulp, except a pink spot situation, nothing unusual took place..

I primed and bonded the open area of canine and finished the top layers without spending much time. The lateral on left was a challenge as it needed mesial built up, at the same time it was much broader mesiodistally because of the existing space.

There I have added plenty of ochre and brown colour from paint on brush kit.  Fig 03(before) then  fig 04(after)

That mellowed down the distal position of lateral making it virtually invisible!

(I would be happy to get your comments on this)