This very pleasant patient presented to us with a very old upper
crown and bridgework, which had started to recede and looked unsightly. It had caused severe attrition on the lower anterior teeth, with a few teeth
almost worn down to gingival level.
The patient’s GDP had advised extraction of those teeth and the
patient wanted a second opinion. We did a wax-up and a mock-up in
the mouth to see if what we were planning was achievable. To
improve sufficient crown height we did surgical crown lengthening
on lower anterior teeth using a surgical stent given to a periodontal
colleague.
The patient was then referred to the endodontist for elective root
canals on all the four lower anterior teeth. Once root canal was
completed all the teeth were prepared and the placed in temporaries
to assess the occlusion and aesthetics to ensure patient was happy
with result.
Once everything was stable we did definitive impressions for the
final prosthesis and the patient was restored with an increased OVD
with porcelain bonded crown and bridgework on the upper and
lower teeth.
BEFORE
Wax Up and Mockup - For patient information and consent
Lower anterior teeth were surgically crown lengthened , as there was insufficient teeth structure to have a crown placed on it . A stent was given to the periodontal colleague ( from a different wax up ) to help them with knowling the expected crown margin , and they remove sufficient bone to around 3mm below the planned crown margin.
Post crown lengthening - 4 weeks
Tooth Preparations and impressions
Post Operative Result
The Lower Left premolars were virgin teeth so were left to Dhal on the temporaries and in 3 months teeth were in contact, if it did come into occlusion, then the plan was to have a non-prep onlay on the LL4 and a bridge from eth LL5 - the LL7.
Patient was delighted with the result , so was I !!