Our patient had lateral incisors anodontia, microdontia, had one temporary canine still present, maxillary bone development anomaly and also broken molars because of decay.
After solving the decays and extractions, we started orthodontic treatment. The purpose was to rearrange the teeth so we can have crowns and veneers on frontals.
After 3 years of ortho, we had two dental implants for the upper molars, one of them with sinsus lift graft and then ceramic and zirconium crowns screwed in these implants. On the frontal area the very exposed gums were corrected with gingivectomy and temporary crowns/veneers were worn for a few months to let the gums heal but also to agree on the length and the shape of the final teeth.
Our patient wanted "very small and short teeth", so we decided not to follow the ideal ratio for modeling the frontals, as this would cause the final teeth to be too long, in her oppinion. The final crowns helped us reshape the canines as lateral incisors and the first premolars as canines. Good comunication with the patient and understanding all the steps is essential in very complex cases as this one.
