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Smile unaffected by restorations

Unusual cases: Case 1

This case is not anything extraordinary but is different because it required three different types of restorations on three adjacent teeth. Plus it shows a transition from an older restoration to a newer, more advanced and far better situation for this patient. Eight or ten years ago she came in to my office seeking to replace a long missing tooth on each side of her upper jaw. Finances were somewhat of a limiting factor because she had just finished periodontal treatment and implant therapy for a lower tooth. A big cosmetic issue was that because she has advanced periodontal disease and in particular advanced gum recession around her upper cuspids. She also has a very high smile line which makes these areas visible. On top of that she has deep cervical erosion (ditched out areas) on the root surfaces of these teeth. This all complicated our restorative decisions because as good looking as some of our newest materials and techniques are it would have been impossible to hide crown margins on these highly visible areas. What we elected to do at the time was a bit unorthodox but it worked out for longer than I estimated it would. I made hybrid crown and bridge/resin bonded bridge restorations out of a high tech (at the time) composite material. The molars were crowned and the cuspids had resin bonded restorations that did not show at all on the outside of her teeth when she smiled. We knew going in that these would not last a long time but she ended up getting pretty good service out of them. When the time came to replace her left side in the photos she was now ready to undergo more implant therapy to replace the missing tooth. I made a conventional zirconia based (no metal) crown for the molar and the implant. On the cuspid I made a lingual porcelain veneer to restore her bite to proper function. This is not a great looking case in any sense but it is totally unintrusive as far as her smile is concerned and it should last her many years. Oral hygiene is also much easier since these are individual restorations that she can floss normally In the photos the old hybrid restoration remains on the right while the new restorations are on the left.