Prosthetic Tooth Repositioning
Historically, patients with esthetic and functional problems caused by tooth malposition had few treatment options. Often, when therapies such as orthodontics and orthognatic surgeries are completed, the patient can still be faced with the prospect of restorative dentistry to gain full esthetic and functional correction.
For a select group of patients with minor tooth malposition, esthetic and functional correction can be accomplished purely by restorative means. The patient, however, should understand that correction of these malpositions requires a more aggressive preparation of the teeth involved to align the arch form. A diagnostic wax-up is necessary to help determine the amount of tooth preparation required. A preparation guide (silicone or plastic stent) is fabricated from the diagnostic wax-up that is approved by the patient. In some cases, intentional endodontics is required to gain the proper space for the correction of tooth position. It is imperative that the patient is aware of this possibility before any treatment is started.
For this case, the patient presented with a dentally compensated Class II malocclusion. He had been consistently told that his functional and esthetic problems could not be corrected without orthognathic surgery and orthodontics before restorative therapy. In his opinion, the cure was worse than the disease.
After working up the case on study models, I determined that the patient could be helped prosthetically without surgical intervention. The orthodontic approach to unraveling this crowded arch would be expansion, or tipping the teeth in the labial direction. This process would increase the arch length and allow for proper tooth alignment. It would also increase the overjet, resulting in a more Class II-like appearance.
When planning to orthodontically prepare these teeth, correcting the lingual inclination of the clinical crowns had the same effect in gaining arch length. Not much was needed to prepare the facial surfaces. Most of the reduction was on the proximal and lingual surfaces to orthodontically correct the clinical crown angulation with the bur ("diamond-driven orthodontics").
I chose Krystyna Jasinski, CDT, owner and founder of Jasinski Dental Lab in Houston, TX, as the technician because of her specialization in anterior and full-mouth reconstruction and her exceptional ability to create natural esthetics.