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i, it’s Dr. Adrian from Advanced Dental Artistry here in West Perth.

One of the questions that we’re often asked is what are the most complex cases that we deal with. Where people are actually going to lose all their teeth, whether it’s due to decay or maybe gum disease. Or maybe they’ve already lost all their teeth and they’re wearing dentures, and they’re looking at All-On-Four treatment. As long as they’ve got enough bone it’s probably a very simple procedure to actually replace all of their teeth, because we can then place the implants in. And we can actually design the smile in whichever way we want. The actual surgery part is of course very complex, and you do need a very experienced team to actually do this treatment. It becomes much harder though when we need to keep teeth, because naturally, when we need to keep teeth we can’t just place the implants and place the new teeth over the top. We have to work around the teeth we have.

To give you an example of some of these complex cases that we treat, we had saw a patient named Gabby who actually wanted cosmetic treatment when she came to see us. And then when she went home, over the next week or so, she actually tripped over and smashed all of her front teeth. They ended up being, basically, intruded into her jaw, and unfortunately these teeth couldn’t be saved.

She did fracture her upper bones. And her maxilla bone was actually fractured. And because she lost these teeth, we had to then not only do cosmetic treatment, but also replace these front teeth actually with dental implants. And you can see this case from before and after, it is quite graphic of course, because she did have the trauma to her front teeth. But you can see the end result.

One of the other things that’s a very complex case, too, is gummy smile, because gummy smile has a number of reasons why patients are gummy. They can sometimes be just be because of excessive gum, but usually it’s because of excessive gum and also hypermobile lip. These are very challenging cases, because naturally we’re going to keep the teeth, but we have to work around how do we actually do a gum lift, how do we actually engineer the new teeth, and design the smile so that the smile is actually perfect.

The other complex problem we see is actually misalignment of teeth. And there’s really certain, I suppose, different degrees of misalignment. In the cases that we see there are some patients where the misalignment allows us to put porcelain veneers over the teeth in order to correct the position of the teeth. Of course, with these patients, they are offered the option of braces or orthodontic treatment before doing porcelain work. And it’s really up to the patient to make a decision on what they feel most comfortable doing.

The other problem we often see is actually when patients have baby teeth remaining. And this is Jonathan, who has actually come in, and he’s got an issue not only with the fact that his canine teeth are actually in the lateral positions. So instead of being in the correct positions, they’ve actually moved forward. But he’s got baby teeth and he’s got a problem with his bite. And for us to actually get good aesthetics, which is what he wanted for his wedding, we had to do some complex cosmetic treatment in order to actually fix his smile.

The other thing is actually midline issues. Midline issues are very complex, and a lot of the times we’ll find that the midline is not always in the middle of the face for most patients. However, when you’ve only got one front tooth present, this is when it becomes quite challenging. In this case here what we’ve actually got is we’ve got Cameron who’s come to see us. And after a hockey accident, he actually lost one of his front teeth. And the orthodontist unfortunately moved his only front tooth to the middle of his mouth. And you can see his final smile here, what a difference it’s made just to get the proportions of his teeth right, but to also move the midline a bit to give him a great smile.

And the last problem we see is congenitally missing teeth. This means that the permanent teeth didn’t come through. One of the very common congenital missing teeth is the lateral incisor on the front. If the lateral incisor’s actually missing, we’ve only got really two options, either to replace it with dental implants. As you can see in this case where we’ve actually put dental implants in, and then we’ve put some implant porcelain crowns and some veneers on the front teeth in order to improve the smile. All the way through to sometimes the canine teeth are actually in the position, very similar to Jonathan’s case. The canines are in the position of the laterals, and we have to change their shape in order to make the smile look beautiful.

If you have any questions, please give us a ring at 1-800-SMILING. I look to forward one day seeing you in the practice.