SHGDDS 1 BY Steven H. Goldstein, DDS Abstract External resorption is a condition that leads to the irreversible loss of enamel, dentin, cementum, and in some cases bone. Its cause is not fully understood, however, most teeth become non-restorable. In this particular case the effected tooth is adjacent to a single implant supported restoration. In addition it is in the esthetic zone of a young patient. The treatment goal of this case is to maximize the esthetic outcome utilizing all known dental principals and techniques.
2 SHGDDS This patient was treated for a cleft lip and palate. The upper right lateral incisor was congenitally missing and restored with an implant. A close-up view of the effect right maxillary incisor. This tooth is not restorable. Due to the esthetic unpredictably of placing two implants adjacent to each other a two unit cantilevered bridge will be fabricated. Orthodontic therapy was used to erupt the central incisor, with the goal being to preserve as much tissue and bone prior to the tooth being extracted. The central incisor was extracted and The existing implant supported crown was removed. A two-unit cantilevered acrylic provisional was fabricated. This will be a prototype for the final restoration. Cosmetic periodontal surgery was performed to level and align the gingival margins in the esthetic zone. In addition a connective tissue graft was placed into the facial aspect of the extraction site. Front view of healed tissue and new provisional restoration. Patient has bleached her teeth. The central incisor provisional is too long (apically) and will be shortened to match the adjacent tooth.
SHGDDS 3 A Noble Biocare Procera custom abutment was fabricated. Note the pink porcelain stain applied to the subgingival portion of the abutment. This will help with maintaining the color of gingival tissue. Full smile view. This was a very difficult case, however, the patient and I are very pleased with the results. Of course our concern is the longevity of the implant and the supported ceramic restoration. It is my belief that this conservative approach will best serve this patient. In actuality only one tooth was replaced. Look how beautiful the adjacent teeth are without any restorations. In the event of a catastrophic failure additional implants could be placed in the lateral and central incisor sites. Pre-operative view. Esthetically the postoperative case is much more appealing. Final case inserted. An all ceramic two unit bridge was fabricated and cemented to the abutment. No occlusal contact is present in lateral excursions. Full smile view. This was a very difficult case, however, the patient and I are very pleased with the results. Of course our concern is the longevity of the implant and the supported ceramic restoration. It is my belief that this conservative approach will best serve this patient. In actuality only one tooth was replaced. Look how beautiful the adjacent teeth are without any restorations. In the event of a catastrophic failure additional implants could be placed in the lateral and central incisor sites. Pre-operative view. Esthetically the postoperative case is much more appealing.
4 SHGDDS Have Questions??? Please contact me via E-mail: shgdds@mac.com Also, check out my Website for additional information, downloads & how-to papers: www.stevenhgoldsteindds.com You can view my Videos on Dental XP: www.dentalxp.com/xperts/sgoldstein And Follow Me on Facebook: www.facebook.com/stevenhgoldsteindds Want to Learn More? Take a Hands-on Course I Am available for Hands-on dental digital workshops in Scottsdale, AZ or in your hometown. Please contact me above or click on the icons here. Dental Implant Workshops N33 W111 INFORMATION PHOENIX MAGAZINE PHOENIX MAGAZINE
SHGDDS 5 : 10752 N 89th Place, Suite 217 Scottsdale, AZ 85260 (480)614-1597 E-mail: shgdds@mac.com Website: www.stevenhgoldsteindds.com Social Media: www.facebook.com/stevenhgoldsteindds Steven H. Goldstein, DDS Dr. Goldstein received his DDS degree in 1985 from Georgetown University. From 1987-1990 Dr. Goldstein completed the Periodontal Prosthesis program at the University of Pennsylvania. He holds two advanced dental degrees; one in Periodontics and the other in Periodontal Prosthesis/ Fixed Prosthodontics. He maintains a private practice in Scottsdale, Arizona, limited to implant, prosthetic and cosmetic dentistry. He has been involved in photography for over 35 years and teaches courses in dental digital photography.