Fig. 9

This 16-year-old patient lost teeth 21 and 22 in a TDI and a significant amount of horizontal bone loss has occurred and a TDI-related scar affects the movement and appearance of the upper lip. The patient did not want to undergo surgical or orthodontic treatment and an alternative strategy was developed. The images show restoration of the dentition using a combination of resin retained bridgework and composite resin restoration. The patient did not want to undergo bone augmentation, scar revision or implant placement. Following joint paediatric orthodontic, and paediatric restorative clinics, a diagnostic wax up was undertaken. Tooth 23 was reshaped with composite to resemble tooth 22. Tooth 11 was used for an abutment for a resin retained bridge (tooth 22 being the pontic). No tooth structure was removed to achieve this treatment, and the procedures are reversible should the patient wish to consider implants in the future. Unlike implant placement, this treatment was achievable before skeletal maturity, and the patient was able to dispose of the removable partial prosthesis they found uncomfortable