Adam Nulty presents a conservative full-mouth aesthetic restoration case where time was of the essence.
A 25-year-old female patient came into the practice complaining of multiple aesthetic problems with her teeth (Figures 1-6). She was visiting from Australia to see family, who are also patients of the practice.
Dentistry in Australia is very expensive (Australian Institute of Health and Welfare, 2015), especially for restorative cases and she could not afford dental treatment there. The patient visits the UK every six to 12 months, and so could return to the practice for reviews.
The patient had undergone unsatisfactory dental work by several dentists many years ago. On discussion, the patient became quite upset, as she is a photographer and felt very self-conscious about her smile, particularly while working. She wanted to completely renew her smile and feel confident again.
Fig 1-6:Pre-treatment. The patient presented with recession, gapping, discoloured restorations, and missing lower first premolars.
Patient history and examination
Medically, the patient was fit and well. Dentally, the patient had a previous large-scale dental work performed with fillings, extractions, and crown work. The anterior teeth had receded, with now a gap and sensitivity at the margins of discoloured restorations. Socially, the patient did not smoke and drank in low unit quantities per week.
The patient showed no temporomandibular joint issues, a good extraoral soft tissue profile and no intraoral soft tissue issues. An orthopantomogram showed a missing LR5 and LL5; well-obturated root fillings present in the four upper incisors; and bone levels were around 90-100% (Figure 7).
The clinician diagnosed good oral hygiene, missing lower second premolars, and several failed restorations. However, prognosis was very good; the patient was at low risk of caries, particularly after continued oral health education and advice with routine hygiene visits.
Fig 7: A pre-treatment orthopantomogram shows the missing lower first premolars