Dr SK Sameer Hussain1, Dr Vivek Lath2, Dr Saumya Sharma3
1Post-graduate Student
2 Associate Professor,
3 Professor and Head of Department,
Department of Prosthodontics, Crown & Bridge.,
Maitri College Of Dentistry & Research Center, Anjora, Drug. (C.G)
ABSTRACT
To understand the interaction between different streams of dental restorative treatments it is essential for the clinicians to practice various challenges to achieve good results. Smile is an integral part of odontology. Patients come along with the prime aim of achieving esthetics. The dental practitioner could preserve or alter the relationships of the visible elements of the oral region to give the required esthetic result.
This case report describes an inter-relation between prosthodontics, endodontics, orthodontics & periodontology as a part of interdisciplinary dental treatment, because without such approach treatment outcome may be compromised and can necessitate extensive treatments.
Keywords: Anterior Esthetics, Lithium Disilicate, Crown lengthening.
Citations: Hussain S, Lath V & Sharma S. Interdisciplinary Approach to Recreate Anterior Esthetics -A Case Report. J Prosthodont Dent Mater 2022:3(1):87-94.
INTRODUCTION
Today’s patients seeking esthetic dental treatment need to reinforce their look for an improved quality of life and higher self-esteem. The esthetic worth of a cosmetic restoration could also be compromised by alternative factors contributing to the composition of a delightful smile, like quantity of gingival show, gingival design, clinical crown dimensions, and tooth position. To provide the best level of dental treatment varied disciplines of dental medicine ought to be used along.1 adjunctive treatment involves tooth movement designed to reinforce the success of alternative dental procedures necessary to revive function. If existing tooth positions make it impossible or troublesome to insert dental restorations, then treatment ought to become a part of the treatment plan.2 On the other hand, the inter-relationship between endodontics and prosthodontics typically resembles interdependence.
Today, each dental practitioner should have a radical understanding of the roles of those varied disciplines in producing an esthetic makeover, with the foremost conservative and biologically sound interdisciplinary treatment plan possible.3
Thus, within the present case report we tend to emphasize on the interdisciplinary approach employing a combination of prosthodontics, periodontology, orthodonture and endodontics to:
1. Assess and diagnose the case.
2. Resolve the downside to maximum esthetic results for our patient.
CASE REPORT
A 24-year-old male patient reported to the department with a chief complaint of an unaesthetic smile due to lost crown structure of upper front teeth. He gave a history of root canal treatment of the upper right central incisor, whose crown structure had been lost due to trauma 4 years back. He also reported repeated dislodgement of the upper central incisors’ crowns. An oral examination of the patient revealed various findings enumerated in the fig. 1
Fig:1 Intraoral Findings
After complete evaluation of intraoral status (fig 2 & 3) of patient treatment and radiographic diagnosis with the same (fig 4) was started with a periodontal therapy including gingivectomy and osseous recontouring of the gingival soft tissue with 11 and 21. It was followed by closure of surgical site with sutures and placement of temporary crown prosthesis. (Fig 5,6,7) As intraoral examination revealed a crowding in lower anteriors hence an orthodontic treatment was planned simultaneously as a part of interdisciplinary approach. Orthodontic bonding was done with lower arch teeth. (Fig: 8 & 9)
Radiographic and intraoral examinations of 11 shown dislodged crown prosthesis which was planned for re-RCT and post and core prosthesis further. After completion of endodontic treatment, post space was prepared and it was verified by IOPA radiograph. (Fig: 10,11). The core was built with tooth coloured composite cement restoration. (Fig:12). Gingival retraction was done with 11 and 21 for better record of gingival finish lines, and an impression was made with elastomeric impression material (fig:13 & 14).
The impression was scanned and E-max crown prosthesis was milled and fabricated. Fabricated crown prosthesis was then cemented by following the cementation protocol, inner surface of crown was conditioned with 10% hydrofluoric acid and the prepared tooth surfaces were acid etched 37% phosphoric acid. (Fig:17,18) And crown prosthesis was cemented on 11 and 21.fig 18 and 19 shows postoperative intraoral front & lateral profile of patient.
DISCUSSION
To achieve excellence in restorative dental procedures particularly within the anterior dentition, it's needed that each practitioner and ceramist be intimately familiar with the essential principles of natural dental esthetics. to assist the clinicians, offer the most effective esthetic results, mathematical theorems like the “golden proportion”4,5 and also the “golden percentage”6 are planned. However, Lombardi declared that strict application of the golden proportion proved to be too rigid for dentistry. gingival morphology is essential in prosthodontics because it determines the outlines and extensions of the dental prosthesis.7 and may contribute considerably to the ultimate dental and facial esthetics.8,9
There are many periodontal procedures that may modify the gingival contour. they can be classified into 2 categories: subtractive and additive. Subtractive strategies involve increasing the clinical crown length by removing soft tissues, with or without ostial modifications10. These procedures are indicated to re-establish a physiological biological width in cases wherever a fracture line, perforation or the restorative margin are situated subgingivally. lengthening a short clinical crown enhances the retention and resistance forms which will be achieved during a crown preparation. This is often necessary if the clinical crown height is less than 3 millimetres.11 A further advantage of crown-lengthening surgery is the elimination of periodontal pockets. aesthetically, subtractive strategies will increase tooth show and resolve uneven gingival contour.
The gingival apparatus plays a vital role in the overall beauty of an individual’s smile. Esthetic periodontal cosmetic surgery is changing into an indivisible part of dental treatment as patients become progressively more aware of dental esthetics. Therefore, it's necessary for clinicians to remember the various choices, the reliability of those treatment modalities, the consistency of results and also the long-term prognosis. Short crowns and/or excessive gingival display are considered as unpleasant by many patients.12
Tjan et al. described the position of the upper lip line in relation to the teeth and gingiva as an important factor in the esthetics of a smile.13 They reported an anterior crown height display of less than 75% in a low smile and of 75–100% in an average smile.
A high or ‘gummy’ smile, on the other hand, shows the full length of the anterior crown heights, in addition to a band of gingival tissue. Before the decision is made regarding the type of surgical procedure, pre-prosthetic planning of the desired esthetic outcome should be performed. An assessment of the smile line and periodontal parameters is paramount in determining the most suitable treatment plan and surgical approach to correct the excessive gingival display. The surgical management of short crowns by crown lengthening may include gingivectomy or apically repositioned flap, with or without ostectomy. Gingivectomy is indicated in type I altered passive eruption.
CONCLUSION
Orthodontic treatment as an adjunct to prosthodontic and restorative dentistry can significantly enhance a favorable result. A healthy periodontium is a prerequisite for success with any dental treatment. Without a strong interdisciplinary relationship between periodontics and prosthodontic, esthetic, endodontic and orthodontic modalities, the treatment outcome may be compromised. By beginning with esthetics, and taking into consideration the impact on function, structure, and biology, the clinician can use the various disciplines in dentistry to deliver the highest level of dental care to each patient. It really works. We call this process interdisciplinary esthetic dentistry.
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