A Hopeless Tooth Is Not a Useless Tooth

Many clinics would remove all the teeth, cut back the gums and bone, and place an All-on-4. After talking it through with her, we chose a different goal: reverse the damage and restore her with white ceramics only.

With an orthodontist, Dr. Reshad placed small anchors in the lower jaw with a wire between them. Elastics ran from that wire to the upper front teeth, so every time she opened her mouth, those teeth were drawn gently downward, bringing the gum and bone with them.

Over nine months the teeth were slowly extruded. The attachments were moved higher up the roots as the teeth came down, and the teeth were shaped as they moved. This slow orthodontic extrusion grew the bone downward, and the before-and-after X-rays show a clear gain in bone levels.

Once the bone was rebuilt, the teeth were prepared and she wore an aesthetic provisional that confirmed the gums were in the right place. Only then were implants placed, guided so each sat at the centre of its tooth, with some added grafting to reinforce the gums.

While the implants healed, the same lower anchors were used to push down her over-erupted lower front teeth, levelling the lower smile. Showing more than about 1 mm of the lower teeth is unattractive and puts the bite at risk.

With both occlusal planes corrected, a wax-up and provisionals were refined, and she received an FP1 restoration with no pink ceramic at all. That is remarkable for someone who had lost so much bone. Her side profile shows the lip support restored and the flaring gone. It is a case where aesthetics, form, function and speech all came together, led by a prosthodontist coordinating the whole team.

She recently returned to Dr. Reshad's Beverly Hills office to have a single tooth treated, one he had never restored. Everything done for her about 25 years ago was still intact and looked almost exactly as it did on the day it was finished.