you come first
Whatever the issue our team joins together to find solutions in a caring gentle environment.
Project Details
CONCERN
Trauma in aesthetic zone
TEAM
Prof Shahdad & Dr Myint
Services
Implants/RBB//Composites
Duration
minimum 3 weeks +
PROJECT OVERVIEW
When accidents occur it can be an overwhelming time. We are experienced and here to support you and give you the options you need, the moment it occurs and for the future.
Sadly the patient arrived to me straight after an accident with a car . Sadly his front two teeth had fractured, one of which had come out. We had attempted to see as an immediate treatment to reposition the tooth to how it was, and for the other build a temporary filling - both for aesthetic reasons, allow some time for the patient to process what has happened and see if the repositioned tooth fragment would heal and survive. Sadly it was too damaged and the fragment started getting infected - which was a likely occurence.
The fractured tooth needed removing and the patient opted for an implant. You could consider a resin bonded bridge. The other tooth was still vital and therefore only required a composite bonding to repair the large chip.
challenges
Front teeth replacements are always high risk due to the aesthetics and being on full show. It is a patient's smile and it provides confidence.
Getting gum form right, the right volume of bone rebuilt and the shapes and colour of the teeth in harmony to remaining teeth can be challenging.
But we have to remember the most important bit. This patient is a human and a soul and they had gone through so much before seeing us. It is a shock and making decisions upon a shock is hard. So building trust with a stranger who is understandably hoping we can help them is something I bear in mind. I believe listening to your concerns, your feelings, being understanding and providing a safe non judgement free zone so you can be yourself with me is important.
solutions
We did a smile design and took a bone CT scan. We then planned the appropriate implant and studied the scans to see how much bone we would need to rebuild. Prof Shakeel Shahdad has done an amazing clean surgery here using a Straumann Tissue Level implant.
I then looked closely at the characteristics of the adjacent teeth seeing the outline was somewhat triangular with a yellow background hue and with white speckled surface colours on the body of the teeth and then a subtle grey translucent colour at the edge of the tooth. Also there are some natural contours on the surface giving the surface texture.
By studying these features I used different tints and shades of composites and used my artistic side to sculpt the composite to the photo below - trying to recreate the natural features.
We then worked with our lab partners to design and manufacture a crown. A ceramist will look at our photos too and paint the shades of the tooth with porcelain to really recreate the colours of the adjacent teeth.
I also worked hard to tease the gums into the ideal mirrored scalloped shape so there is little to no gaps between the teeth. No gum grafts were done in this case.
impact
As a result, the patient is now back to routine life without worries about the tooth. His quality of life has returned without concerns both socially or personally.
Functionality has been great with confidence to eat hard foods on the implants and 7 years on this implant and composite has been complication free so far.
3
Month From Surgery to Final
7years
Since treatment completed
10/10
Aesthetic risk
7years
Clinically and x-ray healthy
