By: Victor M. Sternberg, D.M.D. 

February 16, 2024 

When the patient appeared in my office she complained about her gums being very inflamed and wanted to save her remaining teeth. She was fearful of dentistry and had avoided it for many years. 

It is obvious from these photographs there is a severe inflammation noted on her palate, and severe bone loss on the lower anteriors visualized on the x-rays. 

We discussed several treatment plans following the treatment of the periodontal problem and the lower incisors 

She was very unhappy about the appearance of her lower front teeth. #24 was terminally immobile and she could not, at that point, bite down. I elected to remove it to make her more comfortable. 

As you can see from the photograph, the aesthetics and the recession of the lower anterior teeth were not acceptable to either of us.

I discussed several treatment plans with her. They included the removal of all four lower incisors and the placement of two implants. She had an aversion to having dental implants. We discussed preparing the two cuspids and making an anterior bridge, however, the position of the right cuspid and bicuspid made it almost impossible to prepare the cuspid since the bicuspid was locked right under the distal of the cuspid. 

Finally I suggested to her that we consider orthodontics to move the bicuspid distally to allow the cuspid to be used in a restoration. 

During the course of treatment, the orthodontist elected to realign the lower incisors and at that point the patient became very happy with her appearance. 

He then bonded the lower incisors, as you can see on the radiograph. At that point the patient was happy to have a better aesthetic result. We discussed the choices at this point. Since she wanted to save her teeth, something had to be done about the lower central incisor with all the

recession and large diastema. We elected to do a gingival graft. Eventually she had bonding done to close the embrasure. At the same time he realigned the maxillary anterior teeth. 

The patient is extraordinarily happy with the outcome. 

The two-year journey from start to finish, without implants and without a fixed prothesis, has given a now 77-year-old patient a smile that has finally given joy since at the same time the orthodontist corrected the malposition of the upper anterior teeth. 

I know there are many ways this could have been done differently but perhaps we should always remember not to throw the baby out with the bath water. 

As always, your feedback is appreciated. 

Yours truly, 

Dr. Victor M. Sternberg

By Westchester Center for Periodontal & Implant Excellence

December 22, 2023