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24.05.2024

Total Smile Rehabilitation

Patient Igor
Date
Time
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Doctors’ teamwork to achieve the desired aesthetic result.

A patient came to our clinic who was not satisfied with the appearance of his smile. After completing orthodontic treatment, there are gaps between his frontal teeth. He was also concerned about the color of his teeth.

Diagnosis

At the initial consultation, we performed necessary photo-protocol, digital scan and CBCT. We identified the teeth that required treatment, as well as surgical correction of the gingival margin was necessary before placing ceramic restorations on the upper jaw. A treatment plan was done and the procedure was agreed upon. It was explained to the patient that we had a lot of work ahead and that he is required to follow a certain discipline and our recommendations. With the patient’s consent, we started the work.

Treatment

General dentistry

The first stage was professional hygiene and treatment of carious teeth by our GD Alina Pavlovets. Under local anesthesia and after installation of rubberdam the carious cavities were treated, composite restorations placed on two lower molars (3.7, 4.7).

Endodontics

The patient referred to Dr. Reyaz for endodontic treatment of two teeth.

On examination tooth 4.3 had deep subgingival cavitation filled with granulation tissue and extending to pulp chamber. CBCT showed radiolucent lesion suggestive of external cervical resorption extending/perforating the pulp chamber. It also showed ballooning defect in the middle third of root confined within the root suggestive of another resorptive lesion (internal and non-perforating). Tooth no. 15 showed no significant clinical signs and was noticed on CBCT evaluation as ill-defined external radiolucent defect on the root surface extending/perforating the root canal system. 

Tooth 43:

Tooth 15

Diagnosis: External cervical resorption with tooth no. 15 and combined External and inter cervical resorption with tooth no. 43

Treatment Process: Treatment done in 2 visits with inter appointment intra-canal medicament (calcium hydroxide). For tooth 15

Visit 1 of tooth no.43: Under local anesthesia and after rubber dam placement access opening was done for tooth no. 43. Inflamed pulp tissue and resorptive granulation tissue was cleared with mechanical debridement and copious irrigation with 5 % sodium hypochlorite solution followed by calcium hydroxide dressing for 2 weeks.

Visit 2 of tooth 43: Under local anesthesia and rubber dam isolation root canal was cleaned, dried and obturated using warm vertical compaction followed by composite restoration in access cavity.

Visit 1 of tooth 15 (Performed along with Oral Surgeon): Under local anesthesia and after rubber dam placement access opening was done for tooth no. 15. Palatal canal was first located and Inflamed pulp tissue and resorptive granulation tissue was partially cleared with mechanical debridement and copious irrigation with 5 % sodium hypochlorite solution. But profuse uncontrolled bleeding from granulation tissue present in external lesion compromised the visibility. Flap was reflected by oral surgeon to debride the tissue from external defect. Once debridement was done and bleeding control achieved ultrasonic troughing was carried out to access the buccal canal which was receded due calcific metamorphosis. Intra procedural cbct was performed to trace the buccal canal after which the canal was successfully accessed, shaped and intracanal calcium hydroxide dressing placed for 2 weeks.

Visit 2 of tooth 15: under local anesthesia and rubber dam isolation canals cleaned, dried and obturated using warm vertical compaction apical to the resorptive defect. The defect and perforation were sealed with MTA and patient referred to prosthodontist for restoration. Patient has been advised follow up.

Locating and negotiation of palatal canal

CBCT tracing for buccal canal

Locating and negotiating buccal canal

Obturation and MTA placement

Surgery

Evaluation of the gingival margins of the upper teeth showed that their zeniths (the uppermost points of the visible portion of the tooth) were at different levels.

In these cases, small gingival corrections are necessary to fabricate aesthetic and symmetrical restorations. We ordered a gingival template from the dental laboratory that indicates how much gingival correction needed in the area of each tooth.

Under local anesthesia, our surgeon Alexander Siniakov performed gingival plasty, placed sutures and gave strict recommendations on care and food restrictions.

After 1 week, the sutures removed. Healing of soft tissues after such procedures takes 1-2 months, so we took a break in the patient’s treatment.

Prosthodontics

After short break, we started the final stage – fabrication and placement of ceramic restorations by our prosthodontist Eduard Ziganshin.

First, a digital design of the future smile was made, which was discussed with the patient and necessary adjustments were performed. The patient already had three ceramic crowns on implants (2.5, 2.6, 3.6), which also had to be replaced due to defects and chipping of the ceramic.

We divided all process into 2 stages: first, the ceramics were fabricated and placed on the lower jaw, and only then we moved to the upper jaw to give the gingiva more time to heal after surgery.

After receiving the ceramic restorations from the laboratory, we try them on, assess the accuracy of fit, aesthetics, and conduct phonetic tests (because teeth are not only aesthetics, but also speech formation). We were satisfied with result and restorations were fixed.

Treatment result

With so many restorations, we invite the patient first after 3-4 days and then after 1-2 weeks to check and correct the bite.

Recommendations. After cementation of ceramic veneers, it is recommended to abstain from colorful food and drinks for 2-3 days.

Time. The entire process of aesthetic rehabilitation of the patient took 3 months.

Cost:

Professional hygiene: 750 AED

Caries treatment: 1.000 AED x2

Endodontic treatment of two teeth: 3.000 AED

Gumplasty: 3.500 AED

Ceramic veneer/crown – 2.100 AED x19

Ceramic crown on implant – 4.200 AED x3

Temporary restoration – 500 AED x22

Doctors who treated

Dr. Eduard Ziganshin
general dentist, prosthodontist;
languages: English, Russian
Dr. Aleksandr Siniakov
specialist Oral Surgery, implantologist, periodontist;
languages: English, Russian
Dr. Riyaz Godil
specialist endodontist;
languages: English, Arabic, Hindi
Dr. Alina Pavlovets
general dentist (endodontics and teeth restoration treatment with microscope);
languages: English, Russian
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