Interdisciplinary planning as a landmark for treatment: Case report with a 2-years follow-up

Abstract Case report: young adult woman with esthetic complaints regarding her smile and frontal teeth aspect. At first glance, the problem seemed to be only the shape of the lateral upper incisors and a small diastema between the central incisors. The diagnosis shared between the orthodontist and the prosthetist led us to consider some other important aspects, such as the deep bite, the teeth inclination and the lips support. All these findings led us to consider that the right way to improve the esthetics of the patient’s smile was to plan an orthodontic treatment. This would serve not only for the distribution of the spaces, but mostly it would improve all other problems, before the restoration of the upper lateral teeth with two ceramic veneers. Results: the treatment plan achieved the right distribution of spaces for upper lateral incisors, significant correction of the incisors inclination with important reduction of overbite and better lip support, upper laterals restorations with ceramic feldspathic veneers, obtaining a good integration with natural teeth satisfying patient complaint. Conclusion: in cases which involve interdisciplinary approach, the fundamental step comes from the beginning, when only an initial diagnosis shared among the team of specialists can define the patient problems from different points of view. In this way, we can better understand the competency fields and plan the right treatment and time sequence.

摘要 病例报告：一名因微笑与前牙外观存在美学缺陷而就诊的年轻女性患者。初诊时，仅观察到患者存在上颌侧切牙形态异常及上颌中切牙间轻度牙间隙（diastema）的问题。正畸医生（orthodontist）与修复科医师（prosthetist）联合开展诊断后，我们进一步发现了其他关键问题：深覆合（deep bite）、牙齿倾斜度异常及唇支撑不足。综合上述检查结果，我们认为改善患者微笑美学的最优方案为先实施正畸治疗。该治疗不仅可合理分配间隙，更能一并解决其余口腔问题，后续再行上颌侧切牙的2颗瓷贴面（ceramic veneers）修复。
结果：本次治疗方案成功为上颌侧切牙合理分配了间隙，显著矫正了牙齿倾斜度，大幅降低了覆合程度并改善了唇支撑效果；最终采用长石质瓷贴面（ceramic feldspathic veneers）完成上颌侧切牙修复，修复体与天然牙融合自然，患者的美学诉求得到满意解决。
结论：对于涉及多学科联合诊疗（interdisciplinary approach）的病例而言，核心步骤始于初始阶段——仅由多学科专家团队共同开展的初始诊断，方能从多角度明确患者的全部口腔问题。借此，我们可清晰梳理各学科的诊疗范畴，进而制定精准的治疗方案与时序规划。