Dave Juliani I think we often forget the power of what we do everyday, esthetically and functionally. This patient presented to our office about 13 months ago. She was considering orthodontic treatment with orthognathic surgery to correct her Class II malocclusion and obvious resulting issues. #2 was hopeless and was extracted with a preservation graft in our office in August of 2016. She completed not only the surgery but also the orthodontic treatment in June of this year.
She presented for records in July 2017 where we did a post ortho/surgery full reconstructive records appointment that included a charting, 3D exam, digital and traditional impressions with bite registration, facebow, and photos. We sent the records to Eddie Corrales at Downtown Dental Designs in San Diego. A wax up and transfer was completed after discussions with the patient as to her final expectations and goals. Emax was the obvious choice based on her function and the natural esthetic properties of the material. I chose MT based on her original color,staining, and age.
Her basic desire was to have a smile she didn't have to think or be worried about, She wanted longer, "less worn down" teeth. Her only real demand was color, which she could only describe as wanting them "bare a** white". We went with BL2.
The ortho and surgery left her almost Class III, but in a great position for the reconstruction. We transferred the wax up one month prior to her prep date and saw her every week and as needed for occlusal adjustments to lock the occlusion into a stable position. She was opened vertically 2mm. As you can see she is challenged vertically, has severe wear, and is slightly opened in the posterior right. She is 36 years old.
I would change a few minor things. The laterals could defn be more mesial inclined. The midline is still off but was post ortho. The patient was thrilled because we gave her what she wanted and she felt stable for the first time in almost 20 years.
After transferring the diagnostic wax up she felt immediately more comfortable and stable.
After one month and five occlusal adjustments she presented for her appointment. Day 1 we completed the Maxillary Arch and Mandibular Posterior. She was in the chair 9 hours. She came back the following morning and we completed the Mandibular Anterior #22-27. Eddie was on site and designed, milled, and finalized all restorations as we continued to prep. Vertical dimension was always maintained by completing the posterior a quadrant at a time.
All restorations were bonded using Variolink Esthetic (Light Shade). Again, slightly white, but she pulled it off easily. She is numb in the photos in the lower anterior and final photos were taken at the end of day 2 appointment.
