Genetic Defect Reconstructive Dentistry
Teeth missing due to common birth defects are not uncommon in dentistry.
Two very unusual cases were treated by Dr. Pohl that demonstrates the range of complexity as it applies to genetic defect reconstruction dentistry itself… and the creative treatments available to dentists who have the ability to develop the unique outcomes desired by patients.
Case #1: Multiple Missing Teeth
In this first example, our patient had an extreme case of genetic
defect from birth that caused the absence of 12 adult teeth. He was simply born without 12 teeth.
The adjacent photo shows the structure of the patient’s affected jaws. A male in his 40’s, he had worn a partial. In terms of overall dental function, our patient did not have the freedom to eat and chew whatever he wanted. Rather, he had to be careful and very selective about what he ate.
Our second photo shows the dramatic results obtained with a complex treatment plan that incorporated multiple dental implants, porcelain onlays and porcelain veneers on the front teeth.
The patient was thrilled with the results. Cosmetically he had gained levels of self confidence that he never had before.
In terms of dental function and occlusion, the patient now claims that he no longer has to decide what he “can eat”, but rather what he “wants to eat.”
Case #2: Reconstruction Cosmetics
Missing lateral incisors in the maxilla (upper jaw) is probably the most common manifestation of a dental related birth defect.
Although at first glance there is the appearance of a full complement of upper teeth, this patient never had lateral incisors. His canine teeth moved in (toward the front teeth), to replace the missing laterals creating an awkward juvenile type of appearance.
In most instances, this common deficit is usually treated during early adulthood, when the final growth spurts have been completed.
This patient however had a cystic tumor on his lower lip which required multiple surgeries to correct. Once the tumor was no longer an important issue for the patient, he turned his focus to making certain cosmetic and functional corrections to his smile.
Many patients with congenitally missing incisors (or other missing tooth structures) have large gaps where the teeth should have appeared. In those cases, a patient can choose implants or bridgework as a treatment to create the full complement of teeth in the upper jaw.
Our patient however did not have any gaps that could accommodate implants or bridgework. The treatment desired by the patient was a cosmetic one in which his tooth structures would be made to appear as a fully matured smile.
Comprehensive Exam and Diagnostic Wax Ups
Dr. Pohl conducted a full examination, complete with stone models and articulation studies. Diagnostic wax ups were created that provided the models upon which Dr. Pohl and the patient would re-design certain cosmetic features of individual tooth structures and gingival (gums) tissue.
Framing the Teeth
The challenge was to make his existing canines look like lateral incisors and his first bicuspids to look like canines. As you can see in the photo, the gingival margin of the bicuspid is lower than his canine (adjacent gumlines are uneven).
To esthetically frame the gum tissue around the teeth, the gum line on a canine should be at the same height as the central incisor.
Laser Gum Reshaping – Gum Lift
A laser gum lift (gingiva recontouring and reshaping) was performed utilizing the Waterlase laser to trim and remove excess gum tissue on both the first and second bicuspids.
Notice how the gum line of the first bicuspid is now level with the canine and the increase in length of the second bicuspid. We allowed the tissue heal for three weeks and then prepared his teeth for porcelain veneers and porcelain onlays.
During the interim, the patient was fitted with temporaries that were fabricated from the diagnostic wax-up that closely resembled the final restorations.
Successful Gum Reshaping and Contouring
In this profile photo, note that the gum tissue that was trimmed by the laser procedure has healed nicely.
Dr. Pohl was able to re-proportion the size of his new laterals and canines and obtain a more balanced and esthetically appearing gum line.
Cosmetic Reconstructive Result
This photo is two weeks after the veneers were bonded. His lower lip is still healing from an additional surgery. The patient now has a mature, well balance, attractive smile that has tremendously affected his self- confidence and esteem.
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