Anterior open bite case wearing Instasmile wants permanent solution

219 Rating(s).


Posted on By Barry Rimmer In Anterior/Esthetic

This young mid twenties patient is asking for a permanent cosmetic solution. She is a mild skeletal Class III with a large anterior open bite, narrow upper arch and missing upper left canine and bilateral cross bite and a large anterior tongue thrust (easy case then!). She was so embarrassed with her smile she has worn an instasmile removable acrylic resin partial veneer for approximately 4 years. You can see the damage this has caused. There is no RMH. The patient can now afford a permanent solution. She does not want surgery and is seeking a quick solution. She is very happy with the cosmetics of the acrylic veneers. Seems too simple just to replace the removable with permanent veneers.Whilst there is decay and gingival inflammation this is under the poorly fittiing appliance. I'm obviously concerned with overall stability

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4 Comments

With a patient this young, I would thoroughly explain the benefits of combined therapies. Orthodontics, SARPE, Orthognathic Sx, and Restorative Dentistry. Whatever other direction is taken will never deal with the true issues at hand. Dr. Salama


Reply

SARPE? surgery and rapid palatal expansion??

The patient is adamant -no surgery as much as I try and its not that easy to obtain quickly in UK on NHS. I have considered doing nothing and backing out of case.


Reply

SARPE is "surgically assisted Rapid Palatal Expansion". IF patient remains adamant about no surgery then you can consider 3rd molar extractions and occlusal adjustments on 2nd and 1st molars to try to close bite somewhat and then Veneers and Nightguard. Good luck Dr. Salama


Reply

Many thanks for comments and suggestions -I would worry that extracting the 8's and adjustments might release mandible horizontally to increase Class III


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Salvin
NovaBone