Composite Reconstructions

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COMPOSITE RECONSTRUCITON MAKEOVERS.

M01

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Patient 1 (MO 1) is a busy surgeon with a hectic lifestyle but decided it was time to:

Protect his teeth from the damage done by grinding (Bruxism), a Pathology
Regain Function and
Improve Aesthetics

This patient exhibited (see fig. 1):

Excessive tooth wear
Yellow discolouration and
Missing teeth

His whole mouth was reconstructed (see fig. 2) with:

Composite Crowns
Composite Bridges and
a Valplast flexible denture

This resulted in:

Improved smile
Profile, as well as
Function (see figs. 3,4,5 & 6)

M02

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Figures 1 & 2 show implant with fibre/composite bridge

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Figures 3 & 4 show placement of lower fibre re inforced composite bridge

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Figures 5 & 6 before and after treatment

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Figures 7 & 8 show improvement in lip support

Patient 2 (MO 2) had one Implant placed 15 years ago at our practice (fig, 1), had moved interstate and lost many teeth due to Gum Disease(fig. 5). The stresses of being a family solicitor may have contributed to her Oral Pathology

On her return it was decided to retain her remaining teeth and reconstruct the lower teeth with fibre reinforced Composite Bridgework (fig. 4) and the upper teeth with a double cantilever fibre reinforced composite bridge on the implant(fig. 2) and a flexible Valplast denture (figs. 6 & 11)

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Figures 9 & 10 show the importance of teeth to appearance and confidence

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Figure 11 show functional and aesthetic restoration of maxilla with retention on one implant

M03

This patient exhibited the signs of severe grinding (Bruxism) namely lost Vertical Dimensionand loss of all the Enamel on chewing surfaces (figs. 1,2,5,& 7). Because tooth wear happens gradually it may not be noticed until very late

Gold pins
GlassIonomer bases and
Composite Crowns were used in this reconstruction

In such situations it is imperative that protective night-time Splints be worn to prevent a reoccurence of the damage

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Figures 1 & 2 show amount of wear from parafunctional day and night clenching and grinding. Note the loss of enamel from the biting surfaces and thewidening of the teeth as they get closer to the gum. Also, note the Reparative Dentineon all teeth and the exposed nerve (arrow) where the speed of tooth wear was greater than the of nerve repair

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Figures 3 & 4 after restoration with composite crowns

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Figures 5 & 6 show restoration of the original tooth length

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Figures 7 & 8 show importance of teeth

M04

This patient is an actor and was not happy with:

the appearance of his teeth and
having to wear Partial Dentures

A solution was found with:

Composite Crowns and
Composite Bridges

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Figures 1 & 2 before and after

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Figures 3 & 4 show replacement of amalgams and tooth build ups in composite. Also see cantilever composite bridge at top right

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Figures 5 & 6 before and after

Mishapen, missing and worn teeth were reconstructed with composite crowns and bridges. Vertical height was also increased slightly to improve the Lower Facial Height and Facial Profile

M05

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Figure 1 shows excessive wear from grinding

Although this patient is young his strong night time grinding (Bruxism) has resulted in:

severly worn front teeth
loss of Vertical Dimension

The lower facial height and the teeth were restored by building up the teeth with Composite Crowns

Dentists will usually recommend the wearing of night Splints to prevent such wear

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Figure 2 shows improvement in appearance after restoration of teeth with composite crowns

M06

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Figures 1 & 2 show before and after treatment

Grinding over the years resulted in:

A negative or reverse Smile an
Loss of Lower Facial Height which was restored with Composite Crowns

M07

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Figure 1 initial presentation

This patient enquired if any thing can be done about (fig. 1):

Unevenly worn teeth (Pathology)
Missing teeth (Function)
Dicolouration (Aesthetic)

With Co-Planning this patients main problems were identified and discussed

Treatment option were presented and it was decided to attend to all three issues by placing Composite Crowns on many teeth

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Figure 2 shows composite crowns

The bite had collapsed due to:

The removal of ten teeth (Upper Right 8,7,5 Upper Left 7,6,4 Lower Left 8,6 and Lower Right 8 and 5) with subseqent tlting and
Uneven grinding (Bruxism)

The bite was opened up at the first appointment with Glass Ionomerwhile the upper front teeth were restored with composite crowns and a cantilever Composite Bridge at the upper left 4 site

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Figures 3,4,5 & 6 show noticeable improvement in lip support after treatment (right)

Note the improvement to the lips with the increased support provided by the crowns and the increased Vertical Dimension

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Figures 7 & 8 Note the improvement in smile from a “reverse” curve on the left to a more “positive” curve that tends to reflect the curve of the lower lip

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Figures 9 & 10 Restoration to a more relaxed and comfortable Smile

As with all cases of parafunctional Grinding a night splint was recommended

M08

This patient had many dental issues:

Extremely deep bite (fig.1) with resulting:
- damage to the tissues of the palate
- wear of the roots of the lower front teeth (fig. 2) and
- gum stripping (figs. 1&2)
Moderate to severe Overcrowding
Gingivitis
Decay under some old Amalgam fillings
Absess under upper right 5 tooth
Cracks in dentine under amalgam fillings
Missing lower right molar
Discolouration
Difficulty Smiling comfortably for many years

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Figures 1 & 2 show crowding, extremely deep bite and tooth damage

Option 1. Involved opening up the bite and improving the appearance withLaser Crown Lenghthening,Composite Crownswith or without an Implant (lower molar)

Option 2. Required Orthodontic banding for over two years followed by bleaching and re assessment as to whether gum surgery and Veneers would be rquired

The patient chose option 1.

Laser crown lengthening was performed on some teeth followed by removal of all old fillings and replacement with composite crowns at a new Vertical Height. Root Canal Therapy was performed on UR5 and a cantilever Composite Fibre Reinforced Bridge replaced the missing molar

This attended to Pathology, restored Function and improved Aesthetics — both the smile and the profile

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Figures 3 & 4 Pre treatment upper (left) and lower (right) teeth

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Figures 5 & 6 Post treatment upper (left) and lower (right) teeth

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Figures 7 & 8 show improvement in smile

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Figures 9 & 10 A much more relaxed smile

M09

This patient owns and runs a beauty and health spa in Canberra and was keen to improve her Gum and dentition

The issues identified at appointment one were:

Parafunctional grinding (Bruxism) resulting in Enamel loss and uneven wear of teeth (fig. 1)
Cross bite of lower right teeth (figs. 1&7)
Crowding of lower teeth (figs. 4 & 7)
Missing both upper canines (figs. 1,2,3,7 & 8)
Midline shift to left (fig. 2)
Heavily restored lower molar teeth (fig4)
Discolouration

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Figure 1 Pre treatment note amongst other issues the crossbite of canine and premolar at left

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Figure 2 after laser crown lengthening

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Figures 3,4,5 & 6 before and after. Upper teeth left and lower teeth right

After Co-Planning where the patients dental issues were fully discussed and options given the patient opted for full mouth composite reconstruction

At appointment two all restorations present were removed and replaced some with Composite Fillings and others with Composite Crowns (figs. 5,6,7 & 11)in order to open the bite. A Fibre Reinforced Composite Bridge (figs. 5 & 10)replaced the left missing canine

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