Keep it Local

Case Study

By Dr. Larson Wayman

A 78-year-old female presented with the chief complaint, “I do not like the color of my lower front teeth.” The patient reported having incisal composites for several years that had chipped, as well as a failing existing bridge #27-29. From an esthetic standpoint, the shade and incisal wear of the lower anterior teeth were clearly compromised and an apparent contrast to the upper anterior restorations that were completed more than 10 years ago. Mounted diagnostic models and a wax-up were used in the diagnosis and treatment planning of this case. The patient was diagnosed with wear due to dentoalveolar extrusion. She was adamant that she would not consider any orthodontic treatment. Her primary objection to orthodontic treatment involved her age and the length of time until the completion of restorations. After several options were discussed with the patient, she elected to have functional crown lengthening with a new bridge #27-29 and crowns #22-26. The pulp chambers of the lower incisors were very receded, so the risk of a pulp exposure was minimal.

The patient was referred to a periodontist, Dr. Lauren Klaus, for functional crown lengthening. Dr. Klaus used the wax-up to fabricate a surgical stent to guide the apical position of bone and gingiva levels for the most optimal esthetic result. After three months of healing post-crown lengthening, the patient was prepared for final restorations. A putty matrix was used to aid in the preparation of the teeth to ensure adequate reduction without over-reduction. The final restorations inserted were lithium disilicate crowns #22-26, and a layered zirconia bridge #27-29. The patient is pleased with the result and is looking forward to enjoying her new smile!

ABOUT THE AUTHOR

Dr. Larson Wayman is a general dentist and the owner of Wayman Family and Cosmetic Dentistry in Oklahoma City. Dr. Wayman is originally from Waco, Texas and attended the University of Texas School of Dentistry in Houston. After completing his Doctor of Dental Surgery, Dr. Wayman completed the AEGD residency program at Oklahoma College of Dentistry. His areas of interest include dental implants and cosmetic dentistry. Dr. Wayman and his wife, Emily, have two young sons, Hayes and Tripp.