CASE REPORT
Diagnosis and Treatment Planning
A male patient presented with a chief complaint of an unattractive smile with several dark areas (Figure 4). A significant fixed prosthodontic restoration had been placed 20 years ago. The existing restorations of concern were a 4-unit fixed bridge extending from teeth Nos. 3 to 6, single-unit crowns on teeth Nos. 7 and 8, and a 3-unit fixed bridge extending from teeth Nos. 9 to 11. Except for tooth No. 7, there was no mobility present. However, the current periodontal bone support was significantly compromised. This individual was a smoker of almost 40 years. He had undergone a variety of different smoking cessation therapies at several points in his life. Unfortunately, there has been no long-term success and he continues to smoke about one pack of cigarettes per day. Despite encouragement, he did not anticipate attempting to again quit smoking in the near future.
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| Figure 4. Pretreatment view depicting numerous aesthetic deficiencies. |
Tooth No. 7 had 90% bone loss, and exudate was present in the periodontal pocket. This tooth required extraction. The remaining abutments had approximately 50% bone loss. Considering this patient’s smoking habit and uncertain periodontal support, fabrication of new fixed restorations were not warranted. The patient was informed that a removable prosthesis would eventually be necessary. He requested a short-term, aesthetic solution. One that he hoped would “last a few more years.”