Page 12 - GP Spring 2020

A Smile Conversion Story – From Terminal to Terrific

By James C. Burden, DMD, FAGD
Today’s dentists can do amazing things to A review of findings concluded that Max- learn that her smile conversion would be
improve the health, confidence, and treat- ine had advanced chronic periodontal completed in a single procedure under an-
ment outcomes for our patients. With tech- disease, advanced carious lesions, failing esthesia.
nology like digital radiography, near-infra- restorations, and occlusal collapse. She
red transillumination, cone beam computed had been wearing a maxillary flipper for a Following her treatment decision, I coordi-
technology (CBCT), and lasers, we, as cli- number of years and, while she did not like nated a team of specialists to assist me in
nicians, have gained a true advantage in the having a removable prosthesis, had grown her smile conversion. Her first referral was
early diagnosis of dental diseases. For ex- accustomed to wearing it. Maxine com- to a periodontal surgeon for implant eval-
ample, periodontal disease indicators can mented that she would rather not have to uation and confirmation of her periodontal
be picked up by assessing crevicular fluid wear a denture if it could be avoided. prognosis. Additionally, she was referred
for pathogens and markers associated with to an anesthesiologist for assessment and
periodontitis. Having the advantage of an After reviewing her records and my notes physician for medical clearance. Lastly,
early diagnosis in the disease process gives of our conversations, I met with Maxine to we met with a highly skilled lab technician
the patient the choice to treat their condi- present her diagnosis and prognosis. I dis- to discuss teeth shapes, shades, and restor-
tion in the most minimally invasive, most cussed with her about the risks associated ative steps that would provide her an opti-
predictable, and often, the least costly way. with untreated dental diseases and what mal esthetic and functional result. With all
At times, we come upon patients who have options were available to her to mitigate referrals and lab work completed, we met
dental disease that has progressed far be- these risks. We discussed the risks, bene- as a team in early January to complete the
yond our abilities to effectively manage it fits, costs, alternatives, and likely outcomes smile conversion. While Maxine was still
with them. Advanced periodontal disease, of a variety of treatment options. She was a bit anxious, she had come to know and
advanced caries, and occlusal dysfunction very engaged with the discovery process trust the members of our team and was very
can lead patients to a terminal dentition. and had multiple, well thought out ques- excited about putting her dental past behind
tions. With the help of a digital smile pre- her and moving on to having an amazing
Case Study view, I was able to provide Maxine with a smile.
Our patient Maxine, a generally healthy
and active 61-year-old female, presented to Following anesthesia, all remaining hope-
our office with a chief complaint of a loose less teeth were removed. A clear acrylic
lower front tooth. She elaborated that she mockup of her proposed immediate pros-
had neglected her dentition for many de- thesis was tried in to assess how much
cades due to fear. Recently, her 6-year-old bone reduction might be necessary prior
granddaughter commented to her, “Grand- to implant placement. The palate served as
ma, you have a loose tooth just like me.” a constant point of reference as it was not
This ultimately motivated Maxine to seek surgically involved in the procedure. (Fig-
out dental care, overcome her fears, and ure 5)
commit to changing her smile. Figure 2 - Initial retracted image.

Following a lengthy discussion with Max- “proposed smile”. (Figure 4) She reviewed
ine about her fears, motivations and expec- the options with her husband and later that
tations, we engaged in a co-examination week, she elected to pursue a dual arch, im-
of her oral condition. Having established mediate implant supported prosthesis. This
mutual trust over a number of consultation approach would provide her with a predict-
visits, she allowed us to take photographs, able platform to retain a fixed prosthesis,
x rays, a CBCT, periodontal measurements, restore 90% of natural chewing efficiency,
and study models of her existing teeth. and eliminate her remaining diseased teeth.
(Figures 1-3) As for Maxine’s fear, she was delighted to
Figure 4 - Virtual proposed smile.

Figure 3 - Initial panoramic x-ray derived from Figure 5 – Clear acrylic mock-up*
CBCT image.
Figure 1 - Initial smile image.

www.nysagd.org l Spring 2020 l GP 12