When I first examined Chris in my office, I knew his case would be life changing. He presented with exten­sive and disfiguring dental caries, which had drastically affected his qual­ity of life. Poor dental esthetics can be emotionally damaging due to the social stigma, and many patients report a reduced sense of confidence and well-being. When a patient confides that he hasn’t smiled in years, it’s an emotional moment. That’s when I realized that this case wasn’t just about improv­ing the patient’s esthetics — it was about removing an obstacle that stood between him and his future goals.

My associate, who first saw the patient, recommended extraction of all upper teeth and lower posterior teeth and replacement with complete and partial dentures. This solution was not accept­able to the patient because he was in the process of trying to enlist in the armed services, and edentulism could complicate his application. In fact, it was likely that he would be rejected by the military because of too many missing teeth, and he didn’t want to take that risk.

I used an iTero Element^® (Align Technology, Inc.; San Jose, Calif.) to perform an intraoral scan. To complete the diagnosis and treatment plan, I also took a CBCT scan to evaluate the extent of endodontic involvement. Before recommending any treatment, however, I decided to take a step back and address his poor oral hygiene, which contributed to his current condition.

It was important for Chris to demon­strate a commitment to his oral health for the long-term success of any planned treatment. I created a detailed dietary and oral hygiene plan that effectively required him to change his lifestyle and discontinue his habits of consuming high amounts of refined sugar and going days at a time without brushing or flossing.

When he returned three months later, he had reduced gingival inflamma­tion and significantly lower plaque accumulation. He showed enough improvement that I felt he was ready for the next step.

I performed endodontic treatment on tooth #10, and I prepared teeth #4–11 for individual crowns. Next, I extracted teeth #1–3, #16, #17 and #30–32. Finally, I took a digital impression, and I used a 3D printer to create reference models.The patient was fitted with BioTemps^® temporaries for about two weeks so I could confirm that his occlusion and speech were correct and that he wasn’t suffering from joint pain. Then, using the fastdesign.io™ Software and Design Station and the fastmill.io™ In-Office Mill, I designed and milled BruxZir^® Esthetic NOW crowns for his anterior and premolar teeth. From the scan­ning stage to designing and milling the crowns, the glidewell.io™ In-Office Solution made the process easy and stress free.

When Chris looked in the mirror for the first time after finishing the treatment, he couldn’t stop smiling. Seeing a patient develop the confidence to smile and interact with others as well as gain the ability to chew efficiently is incredibly rewarding. It’s also a great feeling to help a young person with big aspirations overcome something that could have limited his potential. I’m happy to report that he enlisted in the armed services and is headed to boot camp!