Dear Doctors,

I have a multi-disciplinary case which I would like to share with you and get some advice and feedback. I have attached a pile of photos and the periodontal charting to this post so you can see as much as possible about the case. This middle-aged gentleman wears only a mandibular partial. He has lost posterior teeth which have led to attrition of the anteriors, loss of VDO and extrusion and tipping of the remaining posteriors.

I have several different ideas on how to restore him but I will need to give him a variety of options at different levels of cost, time and invasiveness.Assuming he wishes to correct the VDO, I presume anterior maxillary crowns are needed, along with adjustment of the extruded maxillary premolars +/- endodontic treatment, and then maxillary/mandibular partial dentures. However, the cost for this option may be prohibitive. A less expensive alternative may be extraction of the extruded teeth (or occlusal adjustment to a point where they don't need endodontic treatment) and partials with his existing VDO.

Please keep in mind I am using the International Tooth numbering system so if you respond it may take a few moments for me to convert all of the American tooth numbers to Canadian/International. Any thoughts would be appreciated.... Or if you could point me to a Spears Video module that addresses a case similar to this, I would appreciate it. Thanks!

[image:spear00_perio.jpg]

[image:spear01.jpg]

[image:spear02.jpg]

[image:spear03.jpg]

[image:spear04.jpg]

[image:spear05.jpg]

[image:spear06.jpg]

[image:spear07.jpg]

[image:spear08.jpg]

[image:spear09.jpg]

[image:spear10.jpg]

[image:spear11.jpg]

[image:spear12.jpg]

[image:spear13.jpg]

[image:spear14.jpg]

[image:spear15.jpg]

[image:spear16.jpg]

[image:spear17.jpg]

[image:spear18.jpg]

[image:spear19.jpg]

[image:spear20.jpg]

[image:spear21.jpg]

[image:spear22.jpg]

[image:spear23.jpg]

[image:spear24.jpg]