Interdisciplinary treatment planning for single-tooth restorations in the esthetic zone

This article presents a conservative approach for restoring single anterior teeth in patients with congenitally missing maxillary lateral incisors, emphasizing the importance of interdisciplinary treatment planning. Minor orthodontic treatment was necessary to create the space for implant placement. Once the fixtures were inserted and the temporary abutments connected to the implants, the provisionals were relined with the use of a repositioning stone key. From the diagnostic wax-up, it was decided that in order to attain a satisfying final esthetic outcome, it was necessary to also restore the distal aspect of the central incisors and the right first premolar for anatomical and functional reasons. Finally, after having screwed the abutments on the implants, inducing a torque of 20 Ncm, the metal-ceramic restorations were cemented with temporary cement. CLINICAL SIGNIFICANCE: This article presents a systematic approach for restoring anterior teeth in the esthetic zone using a diagnostic additive wax-up and an interdisciplinary approach to optimize the final esthetic outcome.     

Smile design for the adolescent patient--interdisciplinary management of anterior tooth size discrepancies

Adolescent patients often seek orthodontic treatment to correct spacing of the maxillary anterior teeth. If the spacing is caused by a tooth size discrepancy that affects one or more anterior teeth, an interdisciplinary treatment plan involving orthodontic, restorative, and periodontal treatment is recommended to achieve a harmonious esthetic result. This article describes a clinical approach for treatment of these complex cases, focusing on the importance of tooth form, gingival esthetics, and treatment sequencing.     

Esthetic restorations of maxillary anterior teeth with orthodontic treatment and porcelain laminate veneers: a case report

If orthodontists and restorative dentists establish the interdisciplinary approach to esthetic dentistry, the esthetic and functional outcome of their combined efforts will be greatly enhanced. This article describes satisfying esthetic results obtained by the distribution of space for restoration by orthodontic treatment and porcelain laminate veneers in uneven space between maxillary anterior teeth. It is proposed that the use of orthodontic treatment for re-distribution of the space and the use of porcelain laminate veneers to alter crown anatomy provide maximum esthetic and functional correction for patients with irregular interdental spacing.     

Esthetic improvement in the patient with one missing maxillary central incisor restored with porcelain laminate veneers

This article describes esthetic improvement in a patient with a missing maxillary left central incisor. Space analysis of the anterior dentition showed that minor tooth rearrangement was needed. Optimal space distribution for restorations was attained by orthodontic treatment. Through transforming tooth shape with porcelain laminate veneers, the maxillary left lateral incisor was transformed into central incisor and the maxillary left canine into a lateral incisor. The maxillary right central incisor was also restored for esthetic improvement. In a case of changing a tooth shape with porcelain laminate veneers, pre-treatment evaluation, space analysis and diagnostic wax-up are important factors.     

Unilaterally impacted maxillary central incisor and canine with ipsilateral transposed canine-lateral incisor

Concurrent impaction and transposition of maxillary anterior teeth is uncommon and poses a challenge for dentists. Early diagnosis and management of eruption disturbances benefits esthetic and functional outcomes. This article describes the treatment of a teenager who had impactions of the left maxillary central incisor and canine as well as ipsilateral canine-lateral incisor transposition. Treatment alternatives and effective orthodontic techniques are delineated. To optimize the treatment results, the impacted maxillary canine was surgically exposed and orthodontically distalized with an innovative cantilever. Subsequently, the deeply impacted maxillary central incisor was uncovered and orthodontically mesialized into the arch. Finally, the displaced maxillary lateral incisor was brought into its normal position. The combined surgical-orthodontic approach resolved a difficult clinical issue and avoided additional restorations. An esthetic, functional outcome was achieved and satisfied the patient.     

An interdisciplinary approach for restoring function and esthetics in a patient with amelogenesis imperfecta and malocclusion: a clinical report

This clinical report describes an interdisciplinary approach for the coordinated treatment of a patient diagnosed with amelogenesis imperfecta and malocclusion. The patient's functional and esthetic expectations were successfully met with interdisciplinary treatments, including orthodontics, porcelain laminate veneers, metal-ceramic fixed partial dentures, and direct composite restorations.     

Gingival contour and clinical crown length: their effect on the esthetic appearance of maxillary anterior teeth

Fractured, congenitally missing, or avulsed maxillary incisors can often jeopardize the esthetic appearance of the remaining maxillary anterior teeth after orthodontic treatment. In many cases the unesthetic appearance is related to the irregular clinical crown lengths of either the fractured teeth or those that have been substituted for the missing teeth. The results of five cases with either fractured or traumatically avulsed central incisors are reported. Selective tooth intrusion and restorative techniques were used during the finishing stages of orthodontic treatment to improve the final esthetic result. The advantages and disadvantages of the intrusion technique are discussed.     

Interdisciplinary treatment of multiple maxillary anterior diastemas: case report

This article describes an interdisciplinary (orthodontic and prosthodontic) approach for treating a 28-year-old woman who had multiple maxillary anterior diastemas, insufficient lip support, and inadequate anterior guidance. Although the patient also had diastemas among her mandibular anterior teeth, she declined orthodontic or restorative treatment for this arch. Initially, ceramic orthodontic brackets and polytetrafluoroethylene-coated arch wires were used. Orthodontic treatment involved leveling and aligning the maxillary dental arch, correcting the incisor angulations, and providing appropriate spaces for prosthetic restoration. After orthodontic treatment, IPS Empress 2 crowns were delivered to the six maxillary anterior teeth. This interdisciplinary approach produced a successful outcome and improved esthetics. The patient remained satisfied at the three-year follow-up examination.     

应用多学科联合治疗解决前牙美学区复杂病例（附1例5年随访结果）

上前牙美学区的二次修复及相关治疗在日常诊疗过程中备受关注,此类病例常涉及既往修复体形态不佳、基牙医源性过度预备导致侵犯牙周正常解剖结构以及咬合关系紊乱等问题,进而产生前牙区美学缺陷,给再治疗带来挑战,往往需要多学科联合治疗。文章通过展示1例前牙美学区病例的诊疗全过程,包括病情分析、多学科参与治疗设计、具体实施步骤和修复后效果等,以期为临床多学科联合治疗上前牙复杂病例提供经验。     

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??The aesthetic retreatment of maxillary anterior teeth and the related treatment have been widely concerned in clinical practice. Such kind of treatment often inevitably involves problems like compromised esthetic prosthesis??irritation of normal periodontal structures caused by excessive tooth preparation??and occlusal problems??which then lead to esthetic deficiency of anterior region. These cases full of challenge usually need interdisciplinary approach. The purpose of this article is to provide experience in the clinical application of interdisciplinary approach to dealing with aesthetic problems of anterior teeth??by presenting and analyzing a case with 5 years follow-up.     

Restorative and Invisalign: a new approach

This case report describes an interdisciplinary treatment approach using the Invisalign System (Align Technology, Inc., Santa Clara, California) for orthodontics in combination with restorative dentistry. This combined approach was selected for an optimum esthetic and functional result. This case report demonstrates how a restorative case can be improved with prerestorative orthodontic alignment. The Invisalign System was used for opening the bite anteriorly, space distribution, and midline correction. The restorative dentistry procedures involved veneering to enhance the maxillary incisor length-to-width ratio and provide anterior guidance. The cosmetic alternative treatment modality to conventional fixed orthodontics allowed the clinician to accomplish the prerestorative orthodontic goals to help meet the desires of an esthetically conscientious patient.     

Management of multiple trauma avulsion of anterior primary teeth: a three-year follow-up

Dental trauma can cause physical, esthetic, and psychological problems. This paper presents the case of a 2-year-old boy who suffered multiple avulsions of the maxillary anterior teeth. Treatment consisted of fixed orthodontic appliances with artificial anterior teeth. The clinical follow-up lasted for three years. The procedure for the re-establishment of esthetic and dental function was based on a simple, low-cost therapeutic solution. The child and parents were satisfied with the treatment results.     

Orthodontic treatment of a congenitally missing maxillary lateral incisor

Clinicians agree that, regardless of gender or race, tooth agenesis has become more prominent in recent societies. The congenital absence of one or more maxillary lateral incisors poses a challenge to effective treatment planning for the restorative dentist. However, the one-sided orthodontic approach of just moving canines mesially to eliminate restorative procedures leads to compromise. Adult patients presenting with malocclusions, missing lateral incisors, or anterior crowding but who fail to get proper orthodontic treatment, requesting instead esthetic solutions that do not establish a stable occlusion, proper alignment, and proper axial inclination of the teeth will have compromised esthetic and periodontal results. An evaluation of anterior smile esthetics must include both static and dynamic evaluations of frontal and profile views to optimize both dental and facial appearance. This article presents how orthodontics is combined with other specialties in treating a congenitally missing lateral incisor. One case is used to illustrate how orthodontic treatment is progressed in collaboration with other specialists. CLINICAL SIGNIFICANCE: Patients with missing teeth, crowding, midline deviation, unesthetic gingival contours, or other restorative needs may require the interaction between various specialists. For the successful treatment of orthodontic-restorative patients, an interdisciplinary team effort is vital.     

Functional preprosthetic orthodontics and prosthetic reconstruction with resin-bonded fixed partial dentures

When a resin-bonded fixed partial denture is planned in the maxillary anterior region, special attention must be paid to occlusal diagnosis. Specific instrumental diagnosis is necessary to define the functionally important factors: the anterior teeth, the occlusal plane, the temporomandibular joint, and their three-dimensional relation. The optimal treatment in an anterior-guided occlusion is a complete integration of the retainers in the given tooth form without altering the original inclination of the palatal guiding surfaces of the anterior teeth. In many cases, preprosthetic orthodontics is indicated because of functional and esthetic reasons. The objective is to achieve an anterior tooth position that allows the retainers of a resin-bonded fixed partial denture to be incorporated with the designed inclination of the guiding surfaces, using noninvasive preparation techniques. Preprosthetic orthodontic treatment planning, possible problems, and limiting factors as well as the subsequent prosthetic reconstruction have been described in detail. The interdisciplinary treatment has to be planned individually for each patient, depending on the functional diagnosis and the clinical and anatomic situation.     

Interdisciplinary approach to treating a patient with amelogenesis imperfecta: a clinical report

Treatment of a patient with amelogenesis imperfecta (AI) presents a real problem from both functional and esthetic points of view. An esthetic result also will result in an improvement in the patient's quality of life. This clinical report illustrates the oral rehabilitation of a 24-year-old man diagnosed with hypomature type of AI. The aim of treatment was to both restore esthetics and improve masticatory function. Esthetic expectations of the patient were successfully attained by placing all-porcelain crowns from canine to canine in each arch, 12 crowns total. Moreover, metal-ceramic three-unit fixed partial dentures for the missing mandibular right first molars were fabricated for the patient's masticatory function. Resin composite restorations were applied to the maxillary premolars, the maxillary right first molar, the mandibular left premolars, and the right first premolar to modify the occlusion. No deterioration in the restorations and no pathology associated with the rehabilitation were found at the 1-year recall, and the patient's esthetic and functional expectations were satisfied. CLINICAL SIGNIFICANCE This article provides an overview of an interdisciplinary approach to treating the difficult condition of AI using a combination of treatments to achieve optimal esthetics and function.     

Treatment of class II malocclusion with open bite and absence of central maxillary incisor lost by trauma aided by use of orthodontic mini‐implants

The aim of this article is to report the clinical case of non‐surgical treatment of a Class II malocclusion with anterior open bite, associated with absence of a maxillary central incisor avulsed due to trauma. Treatment proceeded with the use of orthodontic mini‐implants as an anchorage device for intrusion of the maxillary molars and for mesial movement of the lateral incisor to replace the central incisor. Treatment resulted in good occlusion, with anterior and lateral guides, enhancement of the facial profile, and good dental esthetic appearance without the need for prosthetic treatment. The treatment outcome was satisfactory but needs long‐term or permanent retention.     

Combined orthodontic-surgical correction of moderate mandibular deficiency.

Carefully planned, coordinated, and executed orthodontic and surgical treatment is a viable alternative to traditional orthodontic treatment of patients with moderate mandibular deficiency. Recognition of their clinical manifestations is essential to distinguish between relative and absolute mandibular deficiency. If after clinical analysis of the Class II patient, esthetic priorities are established to maintain a balanced relationship between the upper lip and nose and not reduce the prominence of the upper lip, mandibular deficiency must be treated by surgical advancement of the mandible, superior repositioning of the maxilla, and consequent autorotational movement of the mandible forward and upward, or a combination of these procedures. The common denominator of successful therapy of absolute mandibular deficiency involves surgery to advance the mandible; relative mandibular deficiency, on the other hand, is treated by maxillary surgery to reposition the maxilla superiorly to allow forward and upward movement of the retropositioned mandible (autorotation). In actual clinical practice many patients manifest a combination of absolute and relative mandibular deficiency and are treated by maxillary and mandibular surgery. Lateral maxillary osteotomies, in concert with rapid maxillary expansion and genioplasty to alter the dimensions of the chin, are essential adjunctive surgical procedures to achieve three-dimensional esthetic and occlusal balance.     

Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach

BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance.