Expert Restoration Dentist Mitchell Pohl has restored hundreds of smiles to full health and beauty.
Restore your Smile to Full Health and Beauty
Our patient presented as a candidate for full mouth reconstruction. He had orthodontics for several years as a child to treat a particular bite problem. However, after the orthodontic treatment was completed and the braces were removed (when he was approximately 14 years old), his facial bones continued to grow.
He subsequently developed a Class III Open Bite. His upper and lower teeth touched only on the molars, with a half centimeter gap between the upper and lower teeth everywhere else. Our patient eventually developed a prognathic condition, where his jaws projected forward to a noticeable degree (popularly referred to as the Jay Leno look).
Double Jaw Orthognathic Surgery
During the summer break between college and law school, the patient underwent double jaw orthognathic surgery to correct the open bite issue. His maxilla (upper jaw bone structure) was rotated forward and his mandible (lower jaw) was shifted back by removing a small amount of bone. The surgery was coordinated with a second round of orthodontic treatment.
The patient first contacted Dr. Pohl over 15 years after the orthognatic surgery. By that time, he had suffered moderate relapse and his occlusion was far from perfect. He had developed a noticeable cross bite on both sides, and his upper jaw (maxilla) had recessed such that, even when smiling, he barely showed his upper teeth. The adjacent before photo shows the posterior cross bite.
Bite – Malocclusion causes Trauma
The patient was unhappy with his bite both functionally (although the open bite was repaired) and esthetically. His bite was still unstable and the two front teeth made contact before the molars. This premature contact created trauma to the front teeth which caused mobility.
The diagnosis was a Class III Occlusion with an anterior edge to edge bite as well as a bilateral posterior cross bite.
Cosmetically the patient wanted to show more teeth when smiling and wanted a whiter smile. Since the surgery and orthodontics had caused severe gum recession and thinning of the bone, most whitening treatments were prohibitively painful.
The thought of going through a second round of orthognathic of surgery to correct the skeletal discrepancy was not acceptable to the patient. He was looking for another alternative that would involve dental procedures that exceed established standards. Based upon the patient’s desires and reluctance to undergo further surgeries, a plan for a full mouth reconstruction was developed.
Occlusal Diagnostic Impressions
Diagnostic photos and models were made as well as a mounted diagnostic wax-up of a proposed solution. The use of diagnostic impressions in complex dentistry can be critical.
Notice in this impression that the patient’s functional issues are clearly represented and are useful for patients in gaining understanding the significance of certain reconstructive procedures. The gum recession is also evident.
The second photo reflects the cosmetic and functional outcomes based on the application of certain procedures proposed by Dr. Pohl, addressing the specific interests of the patient.
Restorative – Reconstructive Components Exceed Current Dental Standards
The cosmetic and functional outcome sought by the patient, for his particular jaw structure, exceeded current standards in restorative and reconstructive dentistry.
Under the patient’s instruction, Dr. Pohl fabricated enlarged porcelain fused to high noble metal crowns for the posterior teeth which exceeded the normal envelope of function for those teeth in order to correct the posterior cross bite.
The upper front (anterior) teeth were lengthened to approximately 13 mm with Empress veneers, which is beyond the average tooth length of 10.5 mm, and brought forward to overlap the lower incisors. This specification was required by the patient so he could display teeth when smiling.
This creative use of veneer technologies and custom porcelain components provided additional occlusal equilibration (selective alterations to biting surfaces) to transition the front teeth out of traumatic occlusion.
The lower bicuspids were prepared for Wolceram crowns. The upper posterior teeth were prepared for porcelain fused to high noble metal crowns which were built out buccally (towards the cheek) to correct the posterior cross-bite.
Considering the gum recession that was present as well as the loss of bone, there was clearly some risk of jeopardizing the health of those teeth; thus special attention was given to the balancing of the patient’s bite.
An occlusal guard was designed to prevent the occurrence of eccentric forces from clenching or grinding his teeth which was important for maintaining optimal oral health but also for promoting long term endurance of the reconstructive treatments and dental components.
The patient was thrilled with his new smile and had it completed in time for his back stage visit with Paula Abdul at Fox TV’s American Idol Television program.
Going beyond the limits of traditional cosmetic and functional makeover dentistry is possible in certain cases.
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