Age: 40 Gender: Female
- Patient complained of unaesthetic smile and discolored teeth.
- Under went orthodontic correction ten years back.
- Deep bite
- Crowding in the upper and lower anterior teeth
- Missing 14, 24, 42
- Generalized attrition
- Deep Dental caries wrt 25,26
- Existing fpd wrt 12,13,15
- Bony exostoses on the labial aspect of 13,15,16 and 23,25,26
- A periapical cyst wrt 12
- Missing 13, 14, 24, 42
- Root canal treated 15
Alternative Treatment Plan:
- Orthodontic treatment to be repeated ( not considered, as patient was not willing , also would be time consuming process and would not address patients chief complaint)
- Veneers on the upper and lower anteriors ( although posteriors would require crowns due to attrition)
- Extraction wrt 48
- Fpd removal wrt 12,13,15
- Extraction wrt 12 (fractured following RCT and fabrication of FPD ) and immediate implant placement wrt 12, 13.
- Root canal treatment wrt 25,26
- Osteoplasty of the bony exostoses
- Reestablishibng the occlusal plane , Full mouth rehabilitation by hobos technique.
- Preoperative radiographs, photographs and diagnostic casts were obtained. Diagnostic casts were mounted in centric occlusion. Mock preparation was carried out on the models, also were used to educate the patient.
- Root canal treatment was completed wrt 25,26,12.
- Existing ill fitting FPD wrt 12,13,15 was replaced with a new FPD.
- Although, patient reported in 3 months period with fractured 12 upto the cervical portion.
- Clinically, LA was administered, 12 was extracted and immediate implants were placed wrt 12,13. Osteoplasty of the bony exostoses on the labial aspect of the maxillary posteriors was carried out.
- In the following appointment, teeth were prepared and temporized by hobos technique. Patient was observed regularly and corrections with the aesthetics were carried out. Once, the results with provisionals were satisfactory, final restoration of the teeth were completed.
- After a three months period, the implants wrt 12,13 were evaluated and final restorations delivered.
- The implants placed wrt 12,13 were evaluated in 3 months period and the prosthetic phase was completed.
- A regular 6 months evaluation carried out regularly.
- Dr. Sujay Gopal BDS, FICOI
- Dental Surgeon & Implantologist