Cases

The patient, 39 years old, who has been living in Holland for many years, came to the clinic with serious esthetic problems, and also with functional problems. The case was extremely difficult, maybe among the most difficult cases we have ever met. The previous dental work can be noticed, surprisingly it had been executed two years before and it had many deficiencies (fig 1), generating practically a major asymmetry on the entire face (fig 3). When we removed the work we understood why it generated this non-physiognomic asymmetry: the patient did not have one lateral incisor, when she was young she had suffered several failed surgical orthodontic procedures, and at that time the central incisor was exactly in the middle of the upper jaw and the interdental connections were far from correct, both physiologically and functionally. The canine on the left had an accentuated gingival retraction and it would have looked very bad on this length, in a metal-ceramic work. The treatment was executed with two all metal-ceramic bridges, thus restoring both the correct occlusion (the bite) and the physiognomic aspect. Practically we had to divide the space irrespectively of the position of the patient’s teeth, getting to the situation in which the patient’s teeth reached the teeth within the dental work and not near them. In order for the exaggerate length of the canine not to ruin the esthetic result, the teeth section which exceeded the normal length was rebuilt in pink ceramic, that is the gum color. The case was even more difficult because we had to work round the clock because the patient had already bought the plane ticket for the return to Holland and everything was ready in only three weeks and a half !!! Finally the result was exceptional (fig 2, fig 4), the patient being more than happy with it. (see References – Mihaela Balaceanu).

The patient, 32 years old, came to the clinic especially due to functional reasons, as he had suffered several extractions on the right side of the mandible and he could no longer eat on the right side. He also had non-physiognomic fillings on the upper frontal teeth, which we replaced after the teeth whitening procedure (with whitening trays). The case was even more complex than it initially seemed because the upper molars opposite to the dental breakthrough had migrated on vertical so much that they reached the gum of the dental breakthrough (fig 1), and the gingival contour was also lowered by 7-8 millimeters. In this case I explained to the patient that if we had polished the upper teeth in that phase it would have been impossible to create enough space both for the upper and for the lower teeth. So the gingival contour would have generated very short and abnormal upper teeth. In the first phase the only solution was to make a crown extension procedure on the two upper molars. The excellent esthetic result (fig 2) can already be noticed a week after the operation – the gum healed, and the gingival contour was completely restored. The molar crowns got also significantly longer and they could be polished reaching normal dimensions. On the lower arch we decided to use prosthesing with implants and metal-ceramic crowns. At the end the masticator and esthetic functions were restored (fig 3), and the patient declared to be happy with the result.

The patient, being 40 years old, came to the clinic with a fracture on the central incisor (fig1). She was worried that she had to wait until she had a new tooth and she took a one week medical leave, but she was very surprised to find out, one hour later, that the temporary prosthesing (fig2) satisfied the most exigent taste and she decided to resume her activity on the same day. Taking into account that this was the frontal area and that the other incisor had the incisal edge fractured, we decided to make two all ceramic crowns on the two incisors, and the fractured tooth initially required a zirconium post. In ten days the treatment was finished (fig 3), and the patient left very happy with the result.

The patient was 55 years old and she came to the clinic being unhappy with her dental situation both functionally and esthetically. The case was very complicated whereas the patient did not want classic movable prostheses, but she could not afford an oral reconstruction with dental implants, and the maxilla had an advanced bone resorption, being already circumcised by the mandible, which led to a reversed occlusion (fig1). We decided to make a upper skeletal prosthesis stabilized with clasps, and on the inferior level we managed to save all the teeth present on the arch and we executed a metal-ceramic work on the existing teeth and a skeletal prosthesis on the lateral areas, stabilized on coulisses. The result (fig2) was optimal, the patient being very happy both from the esthetic and from the functional point of view.

The patient, 56 years old, came to the clinic, being unsatisfied with her dental situation both from the esthetic and from the functional point of view. The incisors on the maxilla “were practically getting out of her mouth”, the patient not being able to close her lips up, due to this reason (fig 1,2). The upper teeth had an accentuated mobility. On the first stage we executed a surgical periodontal procedure on the upper frontal teeth, followed by a temporary canine-canine prosthesing (fig 3) and we managed to save the mobile teeth. Further on, we chose a total bridge on the lower teeth, and on the upper level a canine-canine metal-ceramic bridge and a skeletal prosthesis on the lateral areas. The challenge was bringing the upper teeth, which were vestibuled, in a correct position, and in order to achieve this we used angulated posts. Finally we managed to get a very good result, the patient’s physiognomy being improved a lot (fig 4).

The patient, being 54 years old, came to the clinic with serious esthetic and functional problems (fig 1). The teeth had a marked uneven abrasion, the occlusion being head to head, and the occlusion plan being very irregular. We chose the treatment by prosthesing with two total bridges. The difficulty was that the teeth were abraded, being therefore very short, which gave the patient an old aspect and the vertical occlusion dimension (VOD) was reduced. By special polishing techniques and by executing very well adapted works we managed to give the patient a very pleasant physical aspect, and at the end he stated that he was feeling much younger due to the new look. (fig2).

The patient, 30 years old, lawyer, came to the clinic being very unhappy with the aspect of her teeth. The problems were related both to color, her teeth being very dark, and to the position, as these were very crowded. (fig.1,3). Initially a teeth whitening was executed, and after that the prosthetic stage followed. As the teeth were vital and healthy we executed a prosthesing with CERAMIC VENEERS (fig 2,4) so that the sacrifice of dental substance to be minimum. After the application of veneers the problem of unpleasant positioning of the teeth was almost totally solved. We could have aligned the teeth on a perfect position, but this would have led to the devitalisation of some teeth and to the treatment with all ceramic crowns instead of veneers, and the patient did not want this because she was very happy she kept the vital teeth, and her smile looked very nice.

The patient, 27 years old came to the clinic, being unhappy with the aspect of the ceramic crown on the lateral incisor. This was inadequate due to its shape, color and especially due to the way it was adapted to the gum level (fig 1). The gum had a chronic irritation, but by correctly adapting the new crown, it regained its normal aspect. We also changed the crown shape, this being now identical with the one of the lateral incisor from the opposite side. All the above mentioned changes occurred after a previous whitening of the teeth. The patient left very happy, as all his teeth were 6 tones whiter, and the new ceramic crown was not any different from the natural teeth (fig 2).

The patient, 28 years old, a lawyer, came to the clinic because he discovered the apparition of cavities under the fillings applied on the central and lateral incisors. Whereas, due to his profession, he has permanent contact with people, he asked us to choose the best solution, so that no one sees that his teeth are filled. We removed the old fillings and the cavity tissue (fig 1) and we applied state of the art fillings with nanohybrid composite, which ensured perfect esthetics, the patient being very happy with the result (fig 2).

The patient, 32 years old, executive manager in a well known Austrian company, came to us due to esthetic reasons. On the level of the central incisor he had a metallic-ceramic crown, incorrectly adapted on the edges, which had generated a chronic irritation of the adjacent gum and a cavity under the dental work (fig 1). As the prosthetic prepared tooth was strongly affected by the cavity, a post was needed (crown-and-root reconstruction). As it was an important esthetic area we used the treatment with ZIRCONIUM post and ALL CERAMIC crown. The gum regained its initial color because the new crown adapted very well, and the metallic support of the crown was removed. (fig 2). Maybe the most important advantage of the all ceramic crowns is that the light penetrates the crown as it penetrates a natural tooth (fig 3) and therefore the esthetic results are really excellent. (fig 4).

The patient, 30 years old, working in an advertising company, came to the clinic due to an edentation which he did not want to prosthesize with a classic work (metal-ceramic bridge). His desire was justified, because the teeth near the dental gap were perfectly healthy and we would not have recommended polishing them in order to make a metal-ceramic bridge. (fig 1). It is a classic case in which the correct treatment is only with dental implants, this procedure having multiple advantages: the close teeth remain intact, the hygiene will be better as compared to the metal-ceramic bridge and the alveolar bone will be more hardly resorbed due to the implant presence.
And not for last, as you can see, the esthetic results are excellent (fig 2).

The patient, 31 years old, businesswoman, came to the clinic determined to improve her smile (she told us: “if I don’t repair my teeth at my age, I will never repair them”). The case was not simple because the incisors were vestibuled (fig 1) , she had opened occlusion and sagittal occlusion (fig 2), everything on a maxilla compression. She was sincere about her previous visits to several doctors, because she wanted to solve this problem, but some of them did not want to treat her due to the difficulty of her case, and the others proposed complex surgical and orthodontic treatments which required a long period of time and she did not approve this. So the only treatment option was the prosthetic one, with all ceramic crowns. The sacrifice of dental tissue was an important one, in order for us to reposition the teeth on the ideal line, but it was worth it, and the patient was very happy that she had the courage to take this step (fig 3). At the end, the patient told us that if we had not given her the trust that the treatment would be worth it, she would have probably kept thinking that at a certain point in her life she should have done this, considering her age, which was not an advanced one.

The patient, 40 years old, businesswoman, came to the clinic being unhappy with the aspect of the central incisors which had fractures on the level of incisal edges. (fig 1). Because the situation allowed this, we decided to reconstruct the teeth with fillings of nanohybrid composite which adapts very well and has an excellent esthetic. In order for the fillings to have natural teeth aspect we opted for fillings in successive layers with various degrees of transparency (as the natural teeth have), and the esthetic result is very good (fig 2).

The patient, 17 years old, international top model, came to the clinic being unsatisfied with her teeth color and with the incisal edge of the central incisor on the right (fig 1). The patient insisted that her smile became perfect, as the success of a model can be highly influenced by her smile. Initially we executed a teeth whitening procedure, then the incisal edge of the central incisor was rebuilt (fig 2), the patient being happy with the final result.

The patient, 29 years old, businessman, came to the clinic hoping that we will give him back the smile he used to have. The case was difficult because the bite was very strong and the lower teeth practically broke the upper teeth (fig 1). In this situation the treatment with composite fillings would not give good results, because the teeth would break immediately (in fact the patient told us that another doctor tried several times to solve this case with composite fillings , but the teeth would break after only a few days). So we used the treatment with metallic-ceramic crowns. After polishing the four incisors, as the teeth had been strongly affected by successive fractures, the prepared teeth proved to be barely resistant, but they did not require crown-and-root reconstruction. At the end the space was redivided so that the bite would not be affected, and the esthetic and functional result was very good.

The patient, 50 years old came to the clinic for esthetical and functional reasons, but mostly because she was frightened by an unbearable pain caused by some implants recently inserted by another doctor, Arabian, on the lower arch. We managed to solve the problem and the pain disappeared and we kept the already inserted dental implants, but we had to change the treatment plan and to insert another dental implant on the lower arch and 5 more dental implants on the upper arch (photo 1).. The patient wanted to have the best for her health so we decided to do the entire reconstruction of her teeth with zirconium dental crowns (foto 2). Although a few dental implants inserted by the other doctor had the margin above the gum, we managed to obtain a good result on the lower arch. On the upper arch we obtained the result the patient wanted, that is almost perfect natural white teeth, so that no one can tell they are not natural (foto 3, foto 4).

The patient, 28 years old, a journalist came to the clinic for esthetical reasons. The patient wanted a perfect smile, but she had a dental alveolar incongruity with crowding on the upper arch. As the patient did not accept the orthodontic treatment for the teeth alignment I decided to use the dental crowns of pressed ceramics, which are very esthetical, as you can notice. Before the teeth polishing, the patient opted for the Brite Smile whitening system.

The patient, 50 years old, came to our clinic both for esthetic and functional reasons. The patient had not been benefiting from dental treatments for a long period of time therefore his teeth did not look good, but those on the frontal area of the lower arch had to be extracted, because they presented third degree mobility. I decided the reconstruction with two metal-ceramic, fixed dental works the final result being a very good one, the patient looking much younger after the application of the dental works.

The patient, 40 years old, came to the Dental Progress Clinic due to esthetical and functional reasons. The left central incisor had a very large periodontal bag on all the root length which had lasted for a few years, the patient being obliged to daily press the adjacent area in order to remove the accumulated pus. Saving a tooth strongly affected by an infection which lasted for a long period represented a challenge. First we did an OPERATION OF PERIODONTAL SURGERY consisting in removing the area strongly affected by infection and bone addiction on the area of bone defect. In order to cover the gum defect area (foto1) we had to do an additional surgery intervention of GUM TRANSPLANT. We basically collected the palatal mucosa from the palate and we transplanted it on the defect area. After three months the infection completely disappeared and the gum was much better; this way we managed to save a tooth that the other colleagues would have extracted, and the patient was very pleased (foto2).

The patient, 28 years old, came to Dental Progress due to functional reasons. The patient was missing the molar on the left side of the upper arch. The unpleasant part was that the bone height was of only 1,8 mm (photo1), and the patient did not want the operation of EXTERNAL SINUS LIFT as she works in a very important bank and could not assume the run the risk of swelling. So we decided to turn to ultrasound surgery by means of the Intralift system to lift the sinus membrane by INTERNAL LIFT SINUS. The choice proved to be correct, as we obtained a height of 15 mm and we placed the implant of 13 mm in the same sitting (foto2), and the patient did not feel any pain or tumefaction at all. Thus, by means of a very modern surgical intervention, minimally invasive, we managed to offer the patient a treatment with dental implant without endangering the professional activity, which made the patient happy.

The patient, 20 years old, a student, came to the clinic due to physiognomic reasons. She lacked several teeth, not because of extractions but because of anodontia (congenital absence of teeth). The patient initially wore orthodontic braces, for the teeth alignment and for the creation of spaces adequate for the application of implants. Although the case seemed very simple, it was not because the quantity of bone in which the implants were supposed to be inserted was very small. On the lateral incisor the bone was too thin. We made a two stage intervention: the first, of bone regeneration, consisted in the SPLITTING TECHNIQUE AND BIOS ADDITION, the result being spectacular. From the crest width of 3mm in which we could not insert the dental implant we got to a 9mm width in which we could insert the dental implant without problem and without pain or discomfort for the patient. The patient lacked also the 6 year upper molars, but the problem was that bone at the edentation had a height of ONLY 1 MM (photo2). We decided to make an operation of CLOSED LIFT SINUS although normally this thing would be impossible. Due to the new ultrasound surgery system, Intralift, what it used to be impossible, now becomes possible and we managed to lift the sinus membrane up to 13 mm (photo3). We should mention that due to this new technique THE PATIENT HAD NO PAIN OR SWELLING, after the operation she looked and she felt like she hadn’t underwent such a complex operation. On the frontal area, the gum had the minimum width, and therefore we decided to use ZIRCONIUM PREPARED TOOTH (photo4) and not Titanium so that the esthetics is perfect. On the zirconium prepared tooth we applied a pressed ceramic crown the result being exceptional. (photo 5)

The patient, 32 years old, came to the clinic due to physiognomic and functional reasons. The upper incisors had a second and third degree mobility and gum retraction on 2/3 of the root length. The lower incisors had a second degree mobility and a 2-3 mm gum retraction.
The patient also presented generalized parodontopathy, in a very advanced stage for the respective age, accusing abundant gum bleeding. We decided to intervene surgically on all the teeth for the “periodontitis” treatment and extract the four upper incisors, which could not be saved any longer.
We decided not to extract the lower incisors, as the USA doctors decided (the patient lives in the USA) but to make a guided bone regeneration. The operations were complex, as we decided to treat everything in two stages.
The first operation meant the extraction of the 4 upper incisors and the immediate insertion of 4 dental implants, and in the same surgery operation, the treatment of “periodontitis” of all the upper teeth, including bone addition, where necessary.
Also, on the 4 implants a provisory dental work was applied immediately postoperatively, so the patient left with the teeth as if nothing had happened.
The following sitting consisted in the treatment of the “periodontitis” of all the teeth on the lower arch and bone addition, including the treatment with Emdogain and Biogide Perio membranes, saving both the frontal teeth, which the USA colleagues intended to extract, and the molar on the right side which presented a very large periodontal bag, of about 10 mm.
After two and a half months, the patient was applied the final dental works, of zirconium, the esthetic and functional result being very good.

The patient, 20 years old, came to the clinic following a traumatism which affected five teeth. The lateral left upper incisor was fractured right on the gum level, the central incisors were fractured in proportion of almost ½, the other two affected teeth suffering only superficial fractures at the incisal margins. The challenge was higher as, because of the very strong traumatism, the teeth were pushed towards the palate and the application of prosthesis became almost impossible since there was not enough room for the ceramic crowns.
In order to make a minimum sacrifice of dental substance we decided to apply on the right central incisor a porcelain veneer and thus we managed to keep the tooth vital. On the left central incisor we applied a entirely ceramic crown and on the left lateral incisor we applied an angulated post of platinized gold and a zirconium crown, the other two affected teeth being reconstructed with feelings in nanohybride composite. Practically the four upper incisors were reconstructed by four different methods, a difficult operation as of matching the final shade of the teeth. Our team stood up to the challenge, and, as the patient declared, the esthetic result was excellent.