A Peg Lateral, A Missing Tooth, and More

March 27, 2018 Richard Hunt DDS

Every patient has a story that makes their case unique. When we embrace their path to treatment and make an effort to understand their motivations, we can provide even more excellent care.

A great example of this simple lesson came in the form of my patient Anne. I knew Anne well, as she ‘grew up’ in our practice and had been a regular patient for many years. This fact added an unexpectedly challenging element to her case. I knew I needed to re-familiarize myself with her interests and background instead of taking our past relationship for granted.

Restorative Case For a Future Hygienist

Anne is nineteen and currently training to become a dental hygienist. Her personal dental experiences spurred her interest in the field. She’s excited to provide patient care that improves both oral health and self-image.

All of these details about Anne informed how I approached her treatment. Her primary esthetic concerns were a peg lateral #7 and a congenitally missing #10. She also had canted axial alignment, mottled enamel, and uneven gingival zeniths with a high smile line.

We decided on comprehensive restorative treatment approach that would correct these problems and provide her with a result she could readily show off. The treatment consisted of orthodontics, an implant for #10, and periodontal surgery to reposition gingival levels. We also moved ahead with occlusal equilibration and a diagnostic wax up.

To round out the case, we did tissue sculpting on #10 in addition to esthetic/functional testing and refinement via provisionals. Anne got beautiful e.max veneers on #5, 6, 7, 8, 9, 11 and 12. Finally, she got an implant supported e.max crown on #10.

Matt Roberts CDT handled the lab side of Anne’s case and did a stellar job. She can now go forth confidently into her career and help others embrace treatment that can change their lives.

What case put a smile on your face recently? We’d love to hear what you think in the comments! 

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E3: Restorative Integration of Form & Function

DATE: October 13 2024 @ 8:00 am - October 17 2024 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 41

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night with private bath: $ 290

This Course Is Sold Out! Understanding that “form follows function” is critical for knowing how to blend what looks good with what predictably functions well. E3 is the phase of…

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About Author

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Richard Hunt DDS

Dr. Richard Hunt is a native of Rocky Mount, NC and represents the third generation of dentists in the Hunt family. He earned his Doctor of Dental Surgery degree from the UNC School of Dentistry in 1989. Dr. Richard has served his profession as president of the NC Dental Society and the Dental Foundation of N.C. He is also a former chair of the Dental Assisting National Board. Dr. Hunt realizes the importance of life long learning and attends over 100 hours of continuing education every year in order to remain knowledgeable about current topics and techniques in his profession. In turn, he also enjoys teaching other dentists about the joy, happiness and satisfaction that can be achieved through patient care based on a trusting relationship and clinical excellence. Dr. Hunt has served as a member of the Visiting Faculty of the Pankey Institute for Advanced Dental Education in Key Biscayne, FL. since 2002. He returns regularly to teach dentists from around the world about the clinical and behavioral skills necessary to lead a progressive, health centered dental practice.

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Case Study: All Porcelain Restorations

February 20, 2018 Glenda Owen DDS

Dive into this case for a look at Dr. Owen’s thought process and treatment protocol leading to porcelain restorations. 

Angela was 27 when she came to us asking about options to improve her smile. She was getting married within a year. She hated the appearance of the bridge #3-6 that had been placed in high school. It was repaired at the buccal margin of #6 the day of delivery. She also said she wanted to avoid implants because of time issues and she didn’t want more crowns.

Patient Background

Angela was congenitally missing #4, 7, 10, 12, 13, 20, and 29. In the past, she had implants to replace the lower bicuspids and said the process took too long. Her previous dentist had placed two upper bridges – #3-7 with pontics on #4 and #7 and #14-10 with pontics on #13 and #10. The space for #12 did not exist.

 

Treatment Plan

I noticed her narrow central incisors compared to her laterals and the general contour and color of the bridges. I knew we could improve her smile with all porcelain restorations. Implants to replace missing teeth and veneers on the centrals would make a difference. We did a wax up that she took home to study, comparing it to the model of her existing restorations. She visited the periodontist who would do the implants and I showed her lots of photos of other cases similar to hers.

Creating Porcelain Restorations

Ultimately Angela agreed with our plan. She had implants replacing #7, 10, and 13. We used Zirconia abutments and e.max crowns, as well as an e.max crown for #14. She opted for a Zirconia bridge #3-5. While she was healing, we made provisional bridges, including the cantilevers for the laterals. She was hesitant about the veneers on #8 and #9, but before we began I removed the bridges and created a trial restoration with the wider veneers and proper bridge contours. I took photos and let her think about it before she agreed. She got married with a beautiful new smile.   

What interesting cases are you currently working on? 

Related Course

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DATE: August 22 2024 @ 8:00 am - August 25 2024 @ 2:30 pm

Location: The Pankey Institute

CE HOURS: 39

Dentist Tuition: $ 6500

Single Occupancy Room with Ensuite Bath (Per Night): $ 290

Transform your experience of practicing dentistry, increase predictability, profitability and fulfillment. The Essentials Series is the Key, and Aesthetic and Functional Treatment Planning is where your journey begins.  Following a system of…

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Glenda Owen DDS

Dr. Glenda Owen practices in Houston, Texas where she lives with her husband Kevin. She is a graduate of the University of Texas Dental Branch in Houston. Dr. Owen is a faculty member and member of the Board of Directors for The Pankey Institute.

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