DAZ SINGH presents a case where he achieved a positive aesthetic outcome with a minimally invasive approach
One of the main issues we hear from our patients is how they would like to have more confidence. For some, they feel that their lack of confidence emanates from their smile. Feeling the need to avoid social and professional situations due to their smile is an issue we can help overcome and help people improve their confidence through their smile.
This patient came to see us to help with her class I malocclusion with moderate anterior spacing. The patient has congenitally missing upper lateral incisors and also lower right central incisor with a retained lower central deciduous incisor. Along with the moderate spacing in her lower arch there were also wear facets on the lower anterior incisors.
We felt we had three issues that we needed to resolve:
- Spacing: After removal of the lower deciduous incisor, there would be increased spacing in the lower 3-3 Closing all this space would give us an increased class II relationship and would effectively provide a different aesthetic issue
- Missing teeth: The patient had congenitally missing teeth, managing the spaces for these teeth and to replace these
- Shape: The shapes of the lower incisors needed to be restored, creating the right vertical dimensions and restoring the correct anterior guidance would be vital to the long term
We discussed orthodontic treatment to reposition the lower teeth to give us the space to restore the lower anterior teeth and also to improve the buccal corridors of the upper arch. The patient preferred to use Invisalign clear aligners to deliver this outcome.
With the aid of the ClinCheck software, we were able to visualise to the patient the overall treatment plan and the benefits of removing the deciduous incisor. We advised against closing all the space in the lower arch and instead re-distributed all the space evenly between the lower incisors.
We discussed replacing the existing PFM Maryland bridges and agreed that dentures would be a step backwards. The ideal replacement would be implant retained crowns; the patient however did not have the budget for this option but didn’t want to rule out this option in the future. We opted to replace the existing PFM Maryland for an all-ceramic Maryland.
The key to aesthetic success would lie in the lower arch. After redistributing the space in the lower arch and having removed the lower deciduous incisor, we completed a wax up of the proposed final outcome. We aimed to replace the missing incisor with an all-ceramic Maryland and restore the incisal edges and close residual spaces with composite restorations.
Life-long retention was provided with Vivera retainers. We had multiple challenges with this case, one of which was to set up the positions for the teeth and not to limit the patient’s Providing a great aesthetic outcome in a minimally invasive fashion was key for success.
Aligner Consulting Speaker. Co-director of Ollie & Darsh, a private dental clinic based in Liverpool, Daz Singh has a special interest in providing aesthetic restorative dentistry and aesthetic orthodontics with aligners and simple fixed appliances. He is president and founding member of the European Society of Aesthetic Orthodontics