Jadhav Vivek
Prosthodontist, FICOI, ITI Member.
Smile Designing of Maxillary
Anteriors in a Trauma Situation.
Case Report: A 26 year old female lady reported to Dr. Jadhav’s Excellence Dental
Solutions with trauma to upper jaw in front region. She meet with an accident
and she felled down on upper front jaw massively. Her appearance was damaged
and she wants corrections from dentist to look like her old appearance. Her
esthetics demands were very high.
Past Medical history
revealed not significant findings.
Past dental history also
shows not significant findings.
An intraoral finding reveals:
- Missing 11
- Fractured 21 (Ellis Class III fracture)
- Palatally placed 21
- Ecchymosis of buccal mucosa seen in relation with 11 & 21
- Tenderness positive with 21
Advised Radiographic Investigation includes following:
- IOPA with 11 & 21
- CBCT in relation with 11 & 21
- Study models
- Blood Investigations
CBCT shows following findings:
- Dento-alveolar Fracture with 11 & 21
- Root piece seen with 11
- Buccal & palatal plate fractured with 21
- Buccal plate fractured with 11
- Root of 21 extruded facially
Treatment Plan:
Surgical extraction of
root piece with 11
Implant placement with 11
Screw Retained PFM with 11
Intentional Root canal
followed by Porcelain fused to metal crown with 21. Predictable outcome of 21
is questionable. If 21 fails to above treatment then will go for Implant and
again Screw retained Porcelain fused to metal prosthesis.
Clinical Rationale:
Implant
placement with ideal guided bone regeneration protocol followed by a meticulous
prosthetic plan execution will provide a long standing and predictable
treatment outcome with 11.
In respect with 21,
fractured buccal plate stabilization and Intentional Root canal followed by
porcelain fused to metal crown treatment will provide a questionable prognosis
for the above treatment.
Treatment Execution:
Surgical
extraction 11, surgical implant placement with 11 followed by bone grafting by
ITI protocol composite autogenous bone graft combined with DBBM (Bio-oss, small
& large Particle size). Buccal Plate of 21 stabilized followed by bone
grafting in similar fashion like 11. Bone grafting covered with Bio-guide
tissue membrane to protect bone grafting to form new bone around implant and
fractured buccal plate with 21.
6 months after,
Provisional crowns were given to 11 & 21 for soft tissue contouring. I have
reproduced soft tissue architecture depicting natural features of gingiva like
stippling, intact interdental papilla, soft tissue collar & scalloping of
gums etc.
Final impressions were
made in elastomeric Impression materials by special care of recording soft
tissues around implant of 11 & 21. Finally screw retained porcelain fused
to metal crown delivered with 11 & routine PFM delivered with 21.
Patient is instructed for
oral hygiene instructions.
Also Instructed for
routine follow ups for every 6 months.
Conclusions:
We
as a restorative Prosthodontist / Implant specialist needs to recreate the
damaged intraoral structures by trauma in to a normal, healthy, functional,
esthetic & predictable treatment outcomes by utilizing optimum surgical,
perio and Prosthodontic protocols.
“My
patient is very happy with the final outcome with a big smile with tears in her
eyes for gaining lost appearance.”
