Mastertrack II: Case Presentations

William B. Williams, DMD, FAGD, MICCMO

Esthetic DentistryOrthodontics-Crown & Bridge-

Removable Prosthodontics

Brenda JohnsonCharity Case

Restored Images: Extreme Makeover Team Patient

Brenda Johnson-

Graduate of the Lucy Hall Freedom Hall Addiction Treatment Program for Homeless Women

Restored Images: Extreme Makeover Team

Established July 2003

• David M. Whitehead, M.D.: Southern Plastic Surgery• Bill Williams, D.M.D.: Suwanee Dental Care• Robert Grace, D.C.: Duluth Multicare• Tim Lao: Sporttherapy, Inc.• Joe & Denise Cardarelli: Joseph Michael Salon & Day Spa

• Jackie Madison: Lifestyle & Weight Mgr.• Diane King: Registered Dietitian

Pre-Op Photographs: Profile

Initial Examination: Sept 2003

Medical History

• Age 49• Tobacco use

• Obesity• High blood pressure• Chemical dependency

• Mental health care

Dental History

• Missing Teeth

• Dental Caries

• Patient Concerns– Poor esthetics

– Speech lisp– Wants teeth

Pre-Tx Panoramic

Pre-Treatment Photographs: Centric Occlusion

Pre-Tx Photographs: Right

Pre-Tx Photographs: Left

Pre-Tx Photographs: Maxillary

Pre-Tx Photographs: Mandibular

Pre-Tx Photographs: Difficult Phonetics

Pre-Tx Photographs: Repose

Diagnosis – Treatment Plan

• Moderate periodontal disease

• Dental caries

• Missing teeth• Attrition

• Scaling-Root Plane• Restorative dentistry

• Orthodontics • Crowns # 4,5,6,11,12• ERA RPD Maxilla

• RPD Mandible

Rationale for Treatment Decisions

• Esthetics compromised: – Missing teeth: RPD better then FPD

– Attrition: Short teeth improved with crowns– RPD Clasps: ERA more esthetic than silver clasps

• Function compromised: – Missing teeth: RPD replace molars / maxillary anteriors– Implants not considered but could have been used– Speech lisp: Improved greatly with maxillary RPD

Mid Treatment: Orthodontics

Midpoint Progress: Sept 2004

•Orthodontics completed: Jan ’04 – July ‘04•Loss of 68 lbs and over 36 inches•Cardiovascular and neural systems much improved•Smoking down from 48 to 5 cigarettes a day•Fried chicken down from 3 pieces per day to one or two a week•Hair style looking very sharp.

Donation of Services for Restored Images Patient

Post Treatment Occlusion

Post-Tx: Right

Post-Tx : Left

Post Tx: Mandibular

Treatment Completed

Before & After

Note the much improved lip supportand posture

Before & After

Treatment Completed: Smile

Brenda Johnson: 17 Office Visits• Initial Visit:

– Exam, radiographs, diagnostic models

• Second Visit:– Non-Surgical Therapy– Restorative resins– Orthodontic bracketing

• Third thru 14th Visits: – Orthodontic chain change– Debracket

• Fifteenth Visit:– Crown preparation

• Sixteenth Visit:– Try in Crowns– RPD Impressions

• Seventeenth Visit:– Cement Crowns– Insert RPD’s

The Unveiling Moment: Brenda’s Friend

Brenda’s First Public Smile

Happy Friends

Happy Over Her New Smile