Treatment Plan for Two Central Incisors
Dennis Hartlieb
Part 1
This patient has a crazy story - when he was a kid he was just walking home from school one day and was shot by another kid with a BB gun - right into tooth #8! He was incredibly lucky that it was his tooth and not an eye, but how crazy is that?! Anyhow, tooth #8 was crowned, and since that time, he has also had #9 crowned.
Related Course: The Maxillary Central Incisor
My treatment plan is very limited:
- Gingivectomy #8, remove crowns #8 and #9, provisional crowns #8 and #9
- Patient to be seen by periodontist for osseous reshaping #8 about 2-3 weeks following provisionalization
- Healing of crown lengthening 3-6 months
- Final crowns #8 and #9
Now, the patient is very cautious and is not certain that he wants to have the crown lengthening done (he understands that there would be an esthetic improvement, but financially is conservative).
So, we are changing our treatment strategy:
1. Remove crowns #8 and #9, provisional crowns #8 and #9, evaluation of tooth structure for functional considerations (ferrule)
2. Consultation with patient to review findings from appointment 1
2. Consultation with patient to review findings from appointment 1
Patient will decide between:
1. Have final crowns made at existing gingival margin positions
2. Follow thru with crown lengthening and treatment as outlined above
The patient understands that there will be a separate (additional) fee for me to go back and GV and reprep and retemp if he decides to have crown lengthening.
2. Follow thru with crown lengthening and treatment as outlined above
The patient understands that there will be a separate (additional) fee for me to go back and GV and reprep and retemp if he decides to have crown lengthening.
Read also: Predictable Esthetic Crown Lengthening
Part 2
Karl came in a couple of days ago like we had discussed for treatment of the two maxillary central incisors.
After local anesthesia, I removed the existing restorations. I then 'sounded to the bone' on the facial of #8, hoping that there was a deep sulcus, and we could look at potentially just doing a gingivectomy instead of full osseous procedure. No luck...sounding was just over 3 mm (2nd image).
I reprepped the teeth - full coverage restorations (3rd image), and placed the provisionals. I also, very quickly, did some prototype bonding on #10 to bring into alignment. In the smile preview pic, you will notice a cant in the patient's smile, so creating more symmetry in the length of #8 and #9, #10 was going to look to short, or more likely, the patient was going to think that #9 was too long.
So I etched, adhesive and placed composite on #10 to get a better smile blend for the patient.
I reprepped the teeth - full coverage restorations (3rd image), and placed the provisionals. I also, very quickly, did some prototype bonding on #10 to bring into alignment. In the smile preview pic, you will notice a cant in the patient's smile, so creating more symmetry in the length of #8 and #9, #10 was going to look to short, or more likely, the patient was going to think that #9 was too long.
So I etched, adhesive and placed composite on #10 to get a better smile blend for the patient.
Karl is returning next week (I think) for discussions about definitive treatment:
1. Leave tissues as they are
2. Crown lengthen for symmetry
2. Crown lengthen for symmetry
Do you have any thoughts on this case before I see Kyle again?
Dennis Hartlieb, DDS, AAACD
DOT Founder
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Meet Dr. Dennis Hartlieb
Dr. Dennis Hartlieb owns his own practice in Chicago,IL and has been teaching dentistry for over 30 years. Dr. Hartlieb is the CEO and the main instructor at Dental Online Training. He is an active member in the American Academy of Cosmetic Dentistry where he’s both an Accredited Member and Examiner for Accreditation.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Dr. Hartlieb is also the President of the Chicago Academy of Interdisciplinary Dentofacial Therapy, and a member of the prestigious American Academy of Restorative Dentistry.
Meet Dr. Angela Luek
Dr. Angela M. Lueck is a Wisconsin native and was the youngest female in her class from Marquette University in 1998. Since completing her residency she has consistently taken more than 100 hours a year of continuing education to keep current on the latest trends, techniques, and materials available in dentistry.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
She volunteers her time to teach at Marquette University providing the students additional training with anterior and posterior bonding techniques as well as dental photography. She is also the co-chair of the mentorship program at the University. Dr. Lueck has been voted as one of Milwaukee’s top dentists multiple times by Milwaukee Magazine.
Meet Clare O'Neill
Clare O’Neill is the Director of Operations at Dental Online Training and has a professional background in digital marketing. Clare has certifications in content marketing and digital advertising. Clare has expertise in social media marketing, email marketing, content marketing, website management, and project management. Clare has been using Canva for over 5 years and is a self-proclaimed Canva Queen.
Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
Clare graduated from Georgia State University with a Bachelor’s degree is Sociology. Clare wanted you to know that she is a dog person, loves the colors emerald green and periwinkle, and would eat french fries at every meal if she could!
Meet Dr. Jim Mckee
Dr. McKee is a member of the Spear Resident Faculty. He has maintained a private practice since 1984 in Downers Grove, Illinois where he treats a wide variety of cases with a focus on predictable restorative dentistry. He is a member of the American Academy of Restorative Dentistry and former president of the American Equilibration Society.
He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
He has lectured both nationally and internationally for over 25 years and directs several study clubs. Dr. McKee graduated from the University of Notre Dame in 1980 and earned his dental degree from the University of Illinois College of Dentistry in 1984.
Meet Kirk Behrendt
Kirk Behrendt is a renowned consultant and speaker in the dental industry, known for his expertise in helping dentists create better practices and better lives.
With over 25 years of experience in the field, Kirk has dedicated his professional life to optimizing the best systems and practices in dentistry.
Kirk Behrendt is the founder of ACT Dental, and his vision is driven by the commitment to provide highly personalized care to the dental profession. By creating a talented team of experts, Kirk and his team continue to positively impact the practice of dentistry on practice at a time. Kirk lectures all over the world to help individuals take control of their own lives.
With over 25 years of experience in the field, Kirk has dedicated his professional life to optimizing the best systems and practices in dentistry.
Kirk Behrendt is the founder of ACT Dental, and his vision is driven by the commitment to provide highly personalized care to the dental profession. By creating a talented team of experts, Kirk and his team continue to positively impact the practice of dentistry on practice at a time. Kirk lectures all over the world to help individuals take control of their own lives.
Meet Dr. Melissa Seibert
Melissa Seibert is a comprehensive dentist proudly serving in the Air Force. She holds a dual faculty appointment at Uniformed Services University and Creighton Dental School. She serves on the editorial board for Inside Dentistry.
Her current research projects involve investigating ceramic overlays, zirconia and salivary contamination of universal adhesives. Dr. Seibert is the creator and host of the top dental podcast, Dental Digest. She lectures to national and international audiences.
Her current research projects involve investigating ceramic overlays, zirconia and salivary contamination of universal adhesives. Dr. Seibert is the creator and host of the top dental podcast, Dental Digest. She lectures to national and international audiences.
Meet Olivia Wisden
Olivia Wisden is the founder & CEO of TwoLips Creative. What started as an events discovery app pivoted into a creative agency that specializes in working with startups, small businesses, and organizations who are looking for bold, impactful designs and strategies.
She has worked with dozens of brands over the years ranging from the City of Madison to product launches and beyond.
She has worked with dozens of brands over the years ranging from the City of Madison to product launches and beyond.
Meet Dr. Sofya Kats
Dr. Sofya Kats is local to Milwaukee, WI. She grew up in Bayside and attended Nicolet HS, UW-Milwaukee and Marquette University School of Dentistry. Dr. Kats is a member of the Greater Milwaukee Dental Association, Wisconsin Dental Association, American Dental Association, and The Forum Study Club (oldest Dental Study Club in the United States).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).
Dr. Kats loves the art of dentistry, and healing it can bring to her patients. She volunteers her time by going on international dental mission trips and local events, such as the Mission of Mercy (free dental care sponsored by the Wisconsin Dental Association).
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