Hello there

The following patient is a 55 year old female who attended requesting replacment of her missing upper right first premolar tooth. She had this tooth extracted in may 2012 and since has been wearing a removable partial denture. She is keen to have an implant supported restoration.

She also mentions she is not happy with the gummy smile. Over the years she has had a lot of dental treatment and has had a number of posterior teeth extracted.

Medically she is fit and well and recently quit smoking. She has mild bone loss but mainly stable periodontium with very little bleedng on probing. her occlusion is class 2.

I would like to know what are your thoughts on an ideal treatment plan and the bestay to schedule it? I would like treat as much as possible by myself but happy to refer to specialists if necessary. I have attached photographs and radiographs. the periapicals were taken last week and the bitewings were taken 6 months previously

Tx options I was thinking

1. consider extraction of the upper right 2nd premolar and upper right 1st molar tooth. the upper second premolar has a defective post core crown and the upper right 1st molar also has a failing dentition.

I would then refer for bone augmentation if required or if not place and restore with an implant supported bridge.

2. the lower left 2nd premolar and lowerleft first molar are also failing radiographically.

a) we may be able to restore the the lower left first premolar with a re endodontic treatment and new post core crown. In addition I could refer for re-endontontic treatmentof the LL6 followed by a new coronal restoration?

b) extract both teeth and restore with dental implants.

3. Referral to periodontist for crown lengthening. When looking at the smile line photos increasing the length of the upper anterior teeth may result in long teeth . would it be better to change the occlusion using orthodontics , intruding the upper anterior teeth and extruding teeth (sorry about my photos for not showing occlusion relationships or not having models)

4. restoring the upper 2nd premolar with

i appreciate your time in advance

kind regards

Israr Razaq

BDS MJDF RCS Eng