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Reconstructive Orthodontics - DelayedOrthodontic Porcelain Smile Reconstruction
Common Treatment DelaysIt is not uncommon for people to delay orthodontic treatments. Orthodontists typically recommend treatments at certain growth stages, to take advantage of ongoing growth patterns that can be influenced to create the best orthodontic and cosmetic outcome.As everyone knows, family dynamics, family size and financial resources play a determining role in the delivery of care. Many patients needing orthodontic care often seek treatment well into their adult years. Our patient, pictured here, had this type of treatment history. He deferred comprehensive dental for years. As a result of his bite relationship, he experienced excessive - abnormal wear on most of his teeth. Fortunately, he did not have periodontal problems resulting from his malocclusion. 
His most obvious orthodontic problem was the displaced lower anterior tooth. We had initially treatment planned to remove this tooth; however, the patient wanted to try and save it and remarkably we were able to move it into place.Overcoming Mandibular ToriIn addition to saving the lower anterior tooth, the patient wanted to improve his overall bite relationship.This proved to be challenging because the unusually large mandibular tori on the tongue side and buttressing bone on the facial of his lower molars impeded the movement of the teeth to an ideal position. 
The patient understood that due to his age and the difficulty of the orthodontic movements, treatment time would be extended (movement at young ages is relatively rapid). Defining Treatment Options and GoalsThe patient, a top tier actuarial analyst, was in a position to obtain the treatment that wasn't accessible when he was younger and now sought the text book ideal of how his teeth should be formed.Although the orthodontic issues didn't worsen significantly over the years, the patient nonetheless suffered extreme enamel erosion that affected nearly every tooth. Some erosion had begun to move into and under the gum line. 
Enamel Rehab - Porcelain ResurfacingThe degree of enamel discoloration on the upper tooth structures, as seen in the adjacent photo, was significant, sharing the dark stain characteristics of Tetracycline stains. Professional grade teeth whitening products such as Zoom would not produce uniform bleaching results.A combination of different restorative products was recommended. Porcelain veneer laminates were determined to be the best choice to effectively block the discolorations of the upper/lower anterior teeth. Porcelain onlay veneers were used for the bicuspids and porcelain fused to high noble metal crowns for the posterior. 
The patient elected to use restorative dentistry products that would compete with the best that Mother Nature could provide. He simply wanted the most natural appearance, texture and feel. He did not want to "look" like he had a mouth full of dental crowns.During the diagnostic waxup phase of the restorative treatments (started after orthodontic procedures were completed) our "analytical" patient selected premium porcelain crown and veneer products all produced by DaVinci Dental lab to produce exactly what he wanted. Factors of shading, surface texture, opalescence, incisal shading were adjusted by Dr. Pohl until the perfect crown (as defined by the patient) was created for each tooth requiring crown treatment. 
Temporaries were created and used during this process, to assure that dental cosmetics and a normalized occlusal bite were maintained. The temporaries also served as a guide for the dental lab.Considered a tedious detail by some, the proper use of temporaries with the diagnostic stone models assures that no "unwanted surprises" occur. When working with premium grade porcelain products the patient and doctor only have one chance of "getting it right." Patient Scrutiny RewardedThe patient's overwhelming desire (or demand) to get the treatments he didn't have access to as a child and the requirement of being able to approach text book perfection didn't go unrewarded.The impact upon the patient exceeded what would be expected for any patient completing cosmetic and functional dental reconstruction. The results literally caused changes in his self perception. He became very outgoing (unusual characterstic for actuaries) and now takes every opporunity to smile as broadly as he can. Florida Reconstructive Dentistry Mitchell Pohl, DDS 2900 N. Military Trail, Suite 105 Boca Raton Florida FL 33431 (561) 368-3440 Return to Main Photo Gallery
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