Interdisciplinary Treatment Can Improve Health While Addressing Esthetics
Combining surgical and orthodontic procedures to correct skeletal discrepancies optimizes restorative outcomes
Rebecca Bockow, DDS, MS | Gregg Kinzer, DDS, MSD | Sam Bobek, DMD, MD
When managing interdisciplinary cases, arriving at a correct and complete diagnosis is key to developing an ideal treatment plan, especially when skeletal discrepancies are involved. A 48-year-old female patient presented with a desire to replace her unesthetic maxillary anterior restorations. A comprehensive examination was performed, which revealed an unhealthy skeletal diagnosis. Vertical maxillary excess (ie, excessive maxillary development in the vertical plane) generally coincides with mandibular retrognathia. The occurrence of a downward and backward growth trajectory early in life is often secondary to early childhood mouth breathing. In this case, the patient presented with vertical maxillary excess, mandibular retrognathia, a double posterior crossbite, gingival asymmetry, and unesthetic anterior crowns. Simply replacing the crowns, with or without clinical crown lengthening, would have only addressed the esthetics of the front teeth but would not necessarily have made her healthier. Once the patient understood that a comprehensive treatment plan would not only address her esthetic concerns, but also have the potential to improve her breathing, sleep, and overall health, she was committed to moving forward.
The orthodontic treatment plan included aligning the gingival margins and decompensating the dentition orthodontically. Orthognathic surgery was completed to widen and impact the maxilla and also bring the mandible forward. The surgical treatment plan improved her ability to breathe nasally, created more space for her tongue, opened her airway, and facilitated the development of a healthy occlusal scheme with the teeth loaded on their long axes. After the orthodontic/surgical treatment was completed, the existing full coverage restorations were removed, and provisional restorations were fabricated (Protemp™ Plus, 3M) and placed (Temp-Bond™, Kerr Dental) to act as an esthetic and functional blueprint for the definitive restorations. The definitive all-ceramic restorations were fabricated from lithium disilicate (IPS e.max®, Ivoclar Vivadent).
Upon completion of the treatment, the patient reported experiencing a significant improvement in breathing, sleeping, and overall quality of life. When clinicians work as an interdisciplinary team and understand how to diagnose and treat skeletal discrepancies, they can not only improve esthetics and function but also make patients healthier as well.
About the Author
Rebecca Bockow, DDS, MS
Gregg Kinzer, DDS, MSD
Director of Curriculum and Campus Education
Sam Bobek, DMD, MD
American College of Surgeons