Give Back a Smile -Winter 2007
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Doctor's Perspective
Susan was a victim of lifelong
domestic violence (Fig 1). The
AACD's Give Back A Smile program
referred her to me to evaluate her
case and decide if I would actually
provide her with the dental work.
The day Susan came to my office we
sat down in our guest consultation
suite and talked for a while. She was
excited that her case had been chosen
by GBAS, although extremely
nervous about whether she would
pass the last step of being accepted
by us for treatment. I also learned
that she was very scared of dentistry.
After a thorough oral examination
I found the following conditions
(Figs 2 & 3):
- advanced periodontitis
- missing multiple posterior teeth
- collapsed alveolar bone due to teeth missing for an extended period of time
- overclosed vertical dimension
- failing old restorations
- occlusal disharmony.
Susan wanted to have a beautiful smile and to get it as quickly as possible. My plan was to give her a disease-free mouth, in addition to a beautiful smile. That is why providing her with a smile that included treating only the maxillary anterior six teeth did not achieve my goal. In order to make her smile healthy she had to have a full-mouth reconstruction. The original full-mouth treatment plan, which included implants, was not an option, as Susan wanted to have her new smile as soon as possible. Most volunteer laboratories donate their services for a limited dollar amount or limited number of teeth to GBAS patients, and pro bono full-mouth reconstruction is not part of their commitment. In this case, GBAS had to provide the financial support to the laboratory for their significant additional portion of the work that they did not donate. The treatment plan that was executed was as follows:
- full-mouth records (including study models, facebow, photographs, incisal edge position)
- soft tissue management, including periodontal scaling and root planing, multiple placement of Arestin microspheres (OraPharma, Inc.; Warminster, PA)
- full-mouth diagnostic wax-up
- extraction of #8 and #2; bone graft replacement in the extraction sites
- endodontic treatment of #6, core buildup of #6 and #25
- splinted porcelain-fused-tometal (PFM) retainer for ##2, 3, 5, 6, 7, 9, 10, 11, 13, and 14; and pontic for ##4, 8, and 12
- single PFM for #21 and #27 with ERA attachment (Sterngold; Attleboro, MA); single IPS Empress (Ivoclar Vivadent; Amherst, NY) restoration for ##22, 23, 24, 25, and 26
- precision attachment mandibular removable partial denture replacing ##19, 20, 28, 29, and 30.
Two weeks after the delivery of the final restorations, Susan came in for the evaluation of her new smile (Fig 4). On that day we arranged for a professional make-up artist and hair stylist to come to our office for her glamour shots. Then, after presenting her with a beautiful bouquet of exotic flowers, we sent her to an upscale professional photography...
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