Some cases initially may seem overwhelming. But when the patient’s dental needs are evaluated and envisioned as separate entities, such restorations become much more straightforward. A patient recently presented to our office with a chief complaint of being unhappy with his smile. He was looking for options for straighter and whiter teeth. The examination revealed localized gingival inflammation, a need for a periodontal maintenance visit, and history of scaling and root planing. Occlusal, severe wear was present throughout his dentition, and the anterior teeth were short and uneven in length. Multiple old and failing restorations were present in the posterior teeth. A deep overbite was present, as was severe tooth crowding. Aesthetically, additional findings included a high lip line exposing excessive gingival display along with asymmetrical soft-tissue levels throughout. Multiple old fillings with recurrent caries were present. There was a loss of vertical dimension, as seen with excess freeway space. The teeth were dark, and negative space was present in the posterior. Along with the severe tooth crowding, an uneven occlusal plane and a canted midline were present as well. Recommendations for treatment include treatment of the gingival inflammation with a periodontal maintenance visit, orthodontic treatment to straighten teeth followed by a re-evaluation of the soft-tissue aesthetics, aesthetic crown lengthening with osseous surgery if deemed necessary after orthodontic treatment, aesthetic and restorative rehabilitation with porcelain veneers, crowns, and on lay veneers to replace severely worn enamel while restoring the patient to a better occlusal scheme and function. The patient also was advised that after treatment, lifetime orthodontic retention would be required as well as the use of an occlusal guard during sleeping hours to protect his teeth from his heavy severe bruxism habit. The patient underwent Align Technology Invisalign clear aligner treatment for one year. Toward the end of treatment, a previously treated root canal on tooth No. 3 fractured and required extraction. The tooth was extracted using a minimally invasive technique. Great care was taken to preserve the buccal boney plate, and a corticocancellous allograft was placed to help preserve the ridge, allowing for a predictable implant site in the future. The Invisalign treatment continued for another four months, for a total of 12 months of clear aligner treatment.

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Regards
Sarah eve

Editorial Assistant

Journal of Oral Hygiene and Health