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Central Incisor Attachement Partial:
Case from Mike Hoffman, DDS
This case was completed in 1974 and shown for teleconference discussion.
This patient is a 26 year old African/American male who has just completedfour years of active duty as a Naval Officer and has secured a position in sales with a multi-national corporation. His chief complaint is: "I want to look better for my sales job. Can you improve my smile?"
He is a healthy, fit, moderately athletic individual with a clear health history. He is moving from the area within six months and wishes to have something done prior to his departure.
Significant factors include: Large diastema between upper central incisors, prominent frenum, peg lateral incisors bilaterally, malpositioned teeth, flared maxillary incisors, disproportionate tooth size, good bone index, mouth breather, maxillary periodontal tissues within normal limits. Other information (radiographs, study models, chartings) is not available.
After an orthodontic consultation and work-up the patient chose not to have orthodontic treatment due to time and job location constraints. Due to the large space between the maxillary central incisors and the small size of the lateral incisors, treatment options were limited. The patient also deferred other restorative care because of time constraints.
At the time I elected to do intentional endo on the four maxillary incisors to retain the bone support. I then reduced them to a level just coronal to the gingival tissues. The laterals were restored with silver amalgam to seal the canals and the centrals were fitted with Zest Anchors. A transitional acrylic RPD with wrought wire clasps was delivered to test esthetics and give the patient some experience with eating, speaking, smiling, etc. A chrome cobalt and acrylic RPD was then fabricated with melanin pigmentation and spaces for the male portions of the Zest Anchors. The diastema was narrowed
to maintain a natural look and to allow for a more optimal tooth proportion.
The male portions of the Anchors were placed in the stainless steel female sockets in the central incisors and picked up using cold cure acrylic after the fit, function and esthetics were refined. (Replacement of worn Anchors is easily accomplished by grinding out the old ones and securing new ones with cold cure acrylic resin.)
The patient was delighted with the results and adapted easily to the new appliance. He moved from the area a short time later and I lost touch with him so there has been no active follow up.
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