Recently, Dr. Yan Razdolsky, along with colleagues Drs. Sergio Rubenstein, Barry P. Levin, Elizabeth Razdolsky Michalczyk and Toshiyuki Fujiki, RDT were published as part of their case study in two industry publications helping further stress the importance of interdisciplinary treatment.
The articles, first circulated in the January 2021 online issue of Compendium as a case study titled, “The Importance of Interdisciplinary Treatment in an Esthetically Challenging Case.” The second, published in Inside Dental Technology titled “Interdisciplinary Treatment in an esthetically challenging case” which additionally details fabricating a screw-retained PFM for an anterior implant following the complex orthodontic treatment and interdisciplinary course of treatment.
In both articles, our multidisciplinary dream team shares with readers their clinical case involving a 7-year-old patient with a congenitally missing maxillary left central incisor. Despite having undergone orthodontic treatment, the patient’s smile was unacceptable and in a compromised state for a long-term restorative/prosthetic outcome. Further, the poor course of treatment previously administered resulted in not only considerable expense, but loss of valuable treatment time during a key development period. These issues further led to psychological-social concerns as the patient became shy, introverted and was uncomfortable smiling.
Fortunately, through a referral to our interdisciplinary dream team, and a thorough anatomical evaluation of the adjacent teeth, hard and soft tissue it was finally discovered the missing tooth was associated with a deficient alveolar ridge. Bone grafting would be required and implant position for the replacement tooth taken into consideration in addition to orthodontic space closure. Additionally, flaring of the anterior teeth became a concern as the buccal bone was extremely thin after the previous eight years of failed orthodontic treatment. Using a cephalometric radiograph, the dream team developed and implemented retraction of the upper and lower incisors, occlusal considerations for long-term function of an implant and crown, and a second round of orthodontic treatment.
Upon completion, occlusion and esthetic tooth alignment were evaluated to assess the space allocation on the missing tooth. A radiograph was taken to ensure that the future implant would have adequate mesial-distal space and not be in close proximity to adjacent roots, and a final cephalometric radiograph was taken to evaluate the patient’s profile and proclination of the anterior teeth.
As we learn from these collaborative writings, framing an implant-supported restoration with healthy hard and soft tissue for long-term stability is critical. With a thick, resilient periodontal biotype, a restorative/prosthetic solution is often achievable. When the tissue has experienced recession and/or the surrounding biotype of the tooth/teeth is friable, a more collaborative, and in many instances a surgical, approach may be indicated.
In this case however, the tissue matured and in the final stages of the restoration process, so the laboratory technician could accurately fabricate a final crown unique to the clinical situation using a castable screw-retained prosthetic with 65% gold ceramic alloy and porcelain crown for better long-term management and hygiene.
As this case demonstrates, complex diagnoses require an interdisciplinary team. While treatment may stretch over a long period of time, and not necessarily require every dental specialist be involved throughout every step of the process, it is essential that the treatment team follow the patient’s progress together. As in this case, failure to achieve an ideal outcome with the first phase of orthodontic treatment demanded mid-treatment revision. By following this framework clinicians can help ensure that a successful outcome is achieved, and the patient is happy with the results.
To read these articles in their entirety, please visit Compendium’s website at https://www.aegisdentalnetwork.com/cced/2021/01/the-importance-of-interdisciplinary-treatment-in-an-esthetically-challenging-case and Inside Dental Technology at https://www.aegisdentalnetwork.com/idt/2021/02/