Credit: Dr. Vishtasb Broumand, DMD, MD Vishtasb Broumand
This case report is presented for educational purposes to illustrate the complexities, challenges, and lessons learned in the management of severe maxillofacial trauma resulting from gunshot injury. It emphasizes the importance of multidisciplinary planning, accurate occlusion restoration, and realistic outcome expectations in catastrophic facial trauma.
Case Overview
Patient: 30-year-old female
Timeline: 1 year post-injury at the time of presentation
Initial Injury: Gunshot wound to the oral cavity and face with extensive tissue destruction
Initial Management:
Multiple providers were involved; primary plastic and oral/maxillofacial surgical teams attempted reconstruction with limited success
Temporary mandible plate placed on the inferior border
Fibula graft performed to reconstruct the mandible, but occlusion and alignment were not adequately addressed
Postoperative complications included secondary infection and an anterolateral thigh (LAT) flap for coverage of exposed hardware
Current Presentation (Educational Focus):**
On exam, the patient has an over-contoured fibula graft crossing the left mandible
Severe deficiency of intraoral keratinized mucosa (buccal and lingual) due to blast injury and sequential infections
Minimal remaining intraoral dentition and keratinized tissue
Significant facial scarring with bulky LAT flap on the left cheek
Inability to smile due to lack of teeth and malocclusion
Educational Points
Occlusion-Centric Reconstruction Is Imperative
In severe midface and mandible trauma, achieving proper occlusion is as critical as bony reconstruction.
Even seemingly “simple” grafts (e.g., fibula free flap) require meticulous planning to align occlusal plane, dental arch form, and posterior/anterior stops to restore function.
Preoperative Planning and Multidisciplinary Coordination
Early involvement of dental/oral rehabilitation, maxillofacial prosthodontics, periodontics, and complex craniomaxillofacial surgeons can influence long-term functional outcomes.
Comprehensive assessment of dentition, keratinized mucosa, alveolar bone stock, and occlusal relationships is essential before definitive reconstruction.
Soft Tissue Deficits and Mucosal Reconstruction
Extensive loss of keratinized mucosa presents ongoing functional and prosthetic challenges (speech, swallowing, hygiene, denture stabilization if dentition is possible).
Reconstructive strategies may include soft tissue grafts, local/regional flaps, or staged approaches to optimize mucosal health for future dental rehabilitation.
Infection Risk and Hardware Management
Early placement of plates and hardware in a contaminated field increases risk for infection and exposure; staged reconstruction with robust infection control is critical.
When infection occurs, timely debridement, soft-tissue coverage, and optimization of nutrition and immune status are vital.
Functional and Psychosocial Considerations
Patients with massive facial trauma may experience profound impact on quality of life, self-image, and social functioning.
Comprehensive care should incorporate rehabilitation goals, psychosocial support, and realistic expectation management.
Outcome Realities and Hopeful Pathways
Even with intellectual recognition of limitations, opportunities exist for meaningful functional restoration through:
Dentition restoration strategies (implant-supported prostheses, when feasible)
Guided osseous reconstruction with attention to occlusion
Soft tissue restoration and scar maturation
Rehabilitative therapies (speech, swallow, facial expression)
Closing Remarks
This educational case underscores the critical need for early, multidisciplinary teamwork in complex maxillofacial trauma to optimize occlusion, dentition, and soft-tissue integrity. It highlights the potential for secondary procedures to improve function and aesthetics, even when initial reconstructions fall short of ideal alignment. The reflections herein aim to inform future practice, guide multidisciplinary collaboration, and support patient-centered, realistic planning for severely injured patients.
Beautiful work and an impressive transformation 👏
This case is a great example of how personalized treatment planning can restore both function and aesthetics while maintaining a natural-looking result. The attention to detail and balance really stands out.
🦷 Case credit: Dr. Pedro Miguel Pedro Miguel
✨ Every smile is unique—and this result shows how thoughtful, patient-specific care can make a meaningful difference.
⚠️ Individual results may vary. Shared for educational purposes.
We came across this esthetic crown lengthening before-and-after case originally shared by Dr. Friedberg & Associates and wanted to highlight it for the community.
This case demonstrates how esthetic crown lengthening can enhance smile proportions by carefully reshaping the gum line to reveal more natural tooth structure. Subtle adjustments like these can create a more balanced, harmonious smile when treatment is thoughtfully planned.
📍 Doctor & location: Dr. Friedberg & Associates — Houston, Texas
📸 Case & photo credit: Dr. Friedberg & Associates
⚠️ Disclaimer: Individual results may vary. This case is shared for educational and informational purposes only and does not constitute medical or dental advice.
We came across this impressive before-and-after dental implant case from Dr. Todd Barsky, DDS and wanted to share it with the community.
This case highlights a real patient transformation using dental implants, restoring both function and aesthetics. A great example of how implant dentistry can help patients regain confidence and achieve a natural-looking smile when treatment is carefully planned.
👏 Always appreciate clinicians who share real cases and outcomes.
📸 Case & photo credit: Dr. Todd Barsky, DDS
⚠️ Disclaimer: Individual results may vary. This case is shared for educational and informational purposes only and does not constitute medical advice.
Amazing veneer transformation shared by the original provider 👏
We came across this impressive before-and-after case from Samadian Cosmetic & Advanced Dentistry and wanted to highlight the work.
According to the original post, this photo was taken immediately after delivery of the patient’s veneers. For this smile makeover, the doctor placed ten porcelain veneers to help open up the side smile and improve overall symmetry through subtle, well-planned changes.
✨ A great example of how thoughtful cosmetic dentistry can enhance both balance and confidence.
📸 Case and caption credit: Samadian Cosmetic & Advanced Dentistry
This real orthodontic case showcases a powerful before-and-after transformation completed by the team at Clock Tower Dental. The treatment corrected misalignment and crowding, resulting in a healthier bite and a noticeably more confident smile.
This case demonstrates how orthodontic care—whether with traditional braces or clear aligners like Invisalign—can deliver both functional and aesthetic improvements, including:
• Straighter, easier-to-clean teeth
• Improved bite alignment
• Enhanced smile aesthetics
• Increased long-term oral health and confidence
👏 Credit to Clock Tower Dental for sharing real clinical results that help educate and inspire patients.
➡️ Dentists: Have a before-and-after orthodontic case? Take 5 minutes to log in and share it on Smile Feed. Real cases make a real impact.
#SmileFeed #OrthodonticTransformation #BeforeAndAfter #Invisalign #Braces #DentalCases #DentalEducation #SmileJourney
Saw this before & after smile makeover online by Dr. Arash Azarbal and had to share — such a nice transformation!
It’s cool to see how a thoughtful cosmetic case can change someone’s confidence as much as their teeth 😄
Love seeing real work like this from dentists who post their results.
Before ➡️ After
Smile makeover case performed by Cedar Dental Group.
This transformation highlights how modern cosmetic dentistry can improve balance, function, and overall smile aesthetics. Real before & after cases like this help patients understand what’s possible and allow dentists to showcase their work in a transparent way.
👏 Credit: Cedar Dental Group
Dentists are welcome to share their own cases on Smile Feed — it’s free and open to the dental community.
This case was done by Dr. Michael Apa, and the attention to detail really shows. It’s not about changing who someone is — it’s about restoring confidence and letting their personality come through when they smile.
Being able to see a clear before and after like this helps patients understand what’s possible and feel comfortable taking that step. That’s exactly why Smile Feed exists — real people, real cases, real results.
Grateful for great dentistry and even more grateful to see peoples lives changed.
No joke —this dentists before and after smile makeover pics and it really makes you feel how much a true smile transformation can boost someone’s confidence. Truly life-changing. #SmileGoals
