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Treatment plan

A beautiful, healthy smile of patients is the purpose of all actions.

We therefore try our best to firstly design the smile and then create it according to the best patterns.

We arrange an individual treatment plan for every patient.

It is based on X-ray diagnostics, model analysis, an actual occlusion and patient’s face images, biomechanics principles and fundamental anatomy – a universal, and at the same time unique for each of us.

Troubles with Existence
Dr. Agnieszka Kania
The first prize winner at the National Competition for Doctors of Andrzej Szczeklik of the first and second edition
Maria Sadowska, Game, oil, canvas, 81 x 100 cm, 2009
When she appeared in the doctor’s office, she expressed sadness and loneliness with every fibre of her being. She spoke so quietly that it was barely possible to evaluate the medical history, and almost never opened her mouth. Frightened, she silently repeated “larvatus provedo” – I am walking in disguise.
Melancholy is patronized by Saturn. This is a planet that acedia, or indifference, has been long associated with. The Saturnians often delve into nothingness, they run away from clamour, they cut themselves off from wealth and affluence. They express loss, longing and disappear in seclusion.
They go to the land of divination and magic, look for the answers in art. They choose mourning, think about something that has passed and dream of something unnamed but great, something that encompasses the essence of life and happiness, but at the same time is incomplete. Suffice it to mention Albrecht Dürer and Charles Baudelaire, Søren Kierkegaard, Empress Sissi and Robert Burton as well as the lady from Sadowska’s picture. And she ­– as Sigmund Freud put it – sips grief out of any event.
She sat down at the table (almost all allegories of melancholy depict figure sedens ­– a pensive, sitting figure who immersed herself into the memories), she chose Jack of hearts out of the pack of cards, she showed it to the audience and lowered. Her face – elusive, expressionless, quite similar to the plaster cast, can be the face of women dwelling on nonexistence. Her body of a colour of desert sand can belong to anyone.
In the corner of the picture stands a man ­– sculptural, but with no head or hands. He passed away or has not appeared yet. A young man, a lover, an admirer or also a ghost, personification of “non-human being”, as Kierkegaard put it.
The two of them were probably in the cloistral cell. They are separate from the wall ­− ­­dark brown, with flaky, swollen paint. Only in the middle there is the light coming through the window which is on the opposite side. The glow paints the brighter stain on the wall, a barely legible message or the image of the third character, someone who once came between the two. He destroyed the bond, ruined closeness, brought emptiness. Or maybe it was melancholy that left a sign? It announced the victory, another win in a game called life. It deprived someone of the world and joy again. Morphed into a dead sculpture.
Almost everything is not in place on the canvas. A table without legs levitates in the air, a crumpled tablecloth slightly wavers. A chair is the barely thick canvas folded in half and thrown onto the railing. There is also an empty crystal goblet without a trace of a lipstick and there are apples − still green.
Those two are frozen. She still belongs to the present, although it slowly melts away, loses its sharpness, its contours blur. She lost her glove and feet. She does not look, though has her eyes are open. She looks through the past and indefinite future. Whereas he has already found himself on the other side. Only an obelisk remained after him, an impersonal act.
When she appeared in the doctor’s office, she expressed sadness and loneliness with every fibre of her being. She spoke so quietly that it was barely possible to evaluate the medical history, and almost never opened her mouth. Frightened, she silently repeated “larvatus provedo” – I am walking in disguise. It seemed that her eyes lacked pupils, they blurred and did not look. And yet she saw, only images appeared beyond the eyes. Because this vision is internalized, made of memories, distortions. Such a sight resembles a dream.
I wondered if she would ever remove the curtain that helps her fit into the world. Will she ever raise this third eyelid, will she remove the veil covering her face, will she dare to dispose of camouflage made of prejudice? Before I asked her about gum recession and periodontitis, before she remembered about grinding her teeth and feeling pain in the temporomandibular joints, before she told about the first and the last prosthesis, we had been talking about movies for a long time. She likes Danish films, she eagerly combines images and stories, repeats the scenes and creates her own ones. As if she was trying to create the world from scratch, separate herself from everyday life and experience the second space.
Was her non-identity also related to a lack of smile? − I thought. She actually had the removable prostheses made about six years before, however there was no denture relining, no attempts to keep up with the bone loss. Therefore, when looking at her sunken cheeks, barely visible lips, there was an impression that she had no teeth.
And yet she dreamed about them and also about tasting life. And she wanted to smile again. It eluded her that when she had her mouth full of teeth, she was kind of different.
Patients with implant-supported bridges quickly forget about the pain and torments connected with unstable prostheses in the past. They get their zest for life back, they discover the forgotten senses, relish lost fragrances and flavours. This lady, similarly like the majority of people using removable prostheses, complained mainly about the lower prosthesis.
− It falls out at the slightest movement, ­− she whispered. ­− It’s difficult to say a sentence. Previously formed, ­− she added.
­ − And what about simple sentences? − I asked.
− The same, ­− she laughed. This is how the bond between us was born.
Soon after losing teeth, bones succumb to decay as well. Mandible, made of hard cortical tissue, loses bone slower than a delicate jaw, but it also undergoes significant changes. In the first place they include the side sections of the shaft, which decay four times faster than the front part. The widespread bone degradation often leads to painful paraesthesia and in extreme cases can end up breaking.
Willing to eliminate free lever arms and achieve steadiness, I planned bridges supported by eight implants in the mandible. The acrylic prosthesis, which would be replaced with a fixed prosthesis in future, was placed in the jaw. I chose Camlog implants with a diameter of 3.8 mm and a length of 11 and 13 mm. The bones were rebuilt during implantation in accordance with the idea of ​​guided tissue regeneration.
After four months the upper prosthesis was placed as well as the fixed prosthesis of Carl Misch’ FP 3 type (with the gingival zone). With the dynamics of mandible in mind (provided that it can be regarded as stable in the front section, while it curves and bends from mental foramen to the back), the bridge is divided into two segments. The division made it easier to freely open the mouth, reduced the risk of crown detachment, protected against porcelain damage, bone atrophy around the implants, unscrewing of connectors and finally, against breaking of implants.
The Saturnians doubt, they do not trust and fear something. And hide themselves deeper and deeper. The patient slowly took off the veil. Has the regained smile freed her from the troubles with existence? Her unnamed, once lonely face, deprived of that fragile particle called the “I”, has changed. She does not conceal her joy anymore.

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