CJ Henley, DMD, PA / San Marco, Jacksonville, Florida
Dental case studies in Jacksonville, FL.
Complex and cosmetic cases, from first visit to long-term result.
These dental case studies follow real patients from our San Marco office through diagnosis, planning and treatment. One patient was told her eroded front teeth had to come out; one had been through radiation for tonsil cancer and needed teeth he could chew with; one was losing a front tooth to a root fracture, with too little bone for an easy implant. Each plan started with what that patient’s teeth, bone and bite could support.
- Allteeth saved in the erosion case, no implants
- 10+ yearsthe post-radiation bridge has been in service
- No surgeryand no implants after head and neck radiation
- 4 visitsto replace a fractured front tooth with a zirconia bridge
The short answer
What do these dental case studies show?
These three dental case studies show that the right plan starts with the cause, the biology and the bite, and that teeth other dentists called hopeless can often be kept. Severely eroded front teeth were saved with orthodontics and crowns, a patient treated with radiation for head and neck cancer was rebuilt with a fixed bridge instead of implants, and a front tooth lost to a vertical root fracture was replaced with a porcelain-fused-to-zirconia bridge when bone loss made an implant difficult.
Each case below starts with the patient’s concern, then walks through the clinical thinking, the planning, the treatment and the long-term result. For quick side-by-side photos of more patients, see our before and after gallery. For an overview of this kind of care, read about our complex dental cases in Jacksonville and restorative dentistry.
Case study 1 · Cosmetic and restorative
Saving severely eroded front teeth without implants.
This patient presented with severe dental erosion related to prolonged acid exposure, resulting in significant loss of enamel, shortened teeth, and compromised smile esthetics. She had been told that her only option was extraction followed by implants or a bridge.
In the esthetic zone, those solutions carry real biological and cosmetic challenges, particularly when it comes to maintaining natural gingival contours.
Rather than removing teeth that were still viable, a multidisciplinary approach was used. Orthodontic treatment with clear aligners, done by an orthodontist we work with, created proper space and proportions, allowing for traditional crowns while preserving the patient’s existing gingival architecture.
The result is a smile that is structurally sound, biologically respectful, and intentionally natural, designed to look alive, not artificial.
- Patient concern
- Severe acid erosion of upper front teeth; told extraction and implants were the only option
- Treatment
- Clear aligners with an orthodontist to create space, then layered ceramic crowns
- Teeth saved
- All
- Key takeaway
- Severely eroded teeth can often be restored rather than extracted when space and proportions are corrected first.
Treatments in this case: orthodontics and clear aligners, layered ceramic crowns, cosmetic dentistry and smile design. Related: why do I need a crown? and replacing cosmetic work that looks artificial.
Initial presentation
This patient presented with advanced dental erosion affecting the maxillary anterior teeth. The erosion was severe enough to compromise tooth structure, incisal length, and overall smile harmony. The underlying cause was a past eating disorder, which had resulted in prolonged acid exposure and enamel loss over time.
Beyond the structural concerns, the esthetic impact was significant. The teeth appeared shortened, uneven, and worn, with loss of natural translucency and enamel character. Functionally, the dentition was weakened. Esthetically, the smile no longer reflected the patient’s age or personality.
Prior consultations had led her to believe that the teeth were non-restorable, and that extraction followed by implants or a bridge would be required.
Clinical considerations and treatment philosophy
Implants and bridges can be excellent solutions in the right circumstances. However, in the esthetic zone, particularly the maxillary anterior region, they introduce challenges that must be carefully weighed.
Dental implants require precise management of both hard and soft tissues to achieve a natural appearance. Once natural gingival architecture is lost, recreating it predictably is difficult. Even well-executed implant restorations can appear artificial if the surrounding tissue contours, papillae, or emergence profiles are compromised.
Fixed bridges carry their own biological risks, including preparation of adjacent teeth and long-term maintenance concerns.
In this case, the teeth, while severely eroded, were still viable candidates for restoration if proper space, proportions, and support could be re-established.
Rather than defaulting to extraction-based treatment, a more conservative, multidisciplinary approach was chosen.
Multidisciplinary planning: orthodontics before restorative dentistry
The foundation of this case was orthodontic treatment. The patient wore clear aligners under the care of an orthodontist we work with, with the tooth positions planned around the crowns that would follow.
Orthodontics was used to create proper prosthetic space, re-establish ideal tooth positioning, and correct proportions that had been altered by years of erosion. This step was critical. Without adequate space and alignment, restorative dentistry in eroded cases often leads to over-contoured restorations or compromised esthetics.
By completing orthodontic treatment first, we were able to design restorations that respected both biology and esthetics, without aggressive tooth reduction or artificial contours.
Equally important, this approach preserved the patient’s existing gingival architecture. Maintaining natural soft-tissue contours around the teeth dramatically improves long-term esthetic outcomes and stability.
Restorative phase: esthetics through detail, not excess
Following orthodontic treatment, traditional full-coverage crowns were placed on the maxillary anterior teeth.
The success of this phase relied heavily on collaboration with an exceptional dental laboratory. The ceramics in this case were carefully layered to replicate the optical properties of natural teeth rather than mask them.
Key esthetic principles included:
- Gradual color transitions from cervical to incisal regions
- Controlled translucency at the incisal edges
- Subtle internal characterization rather than uniform opacity
- Secondary anatomy and surface texture to manage light reflection
Surface texture is often overlooked in cosmetic dentistry, but it plays a critical role in how light interacts with a restoration. Proper micro-texture allows light to scatter naturally, preventing the flat, artificial appearance that can make restorations obvious.
The result is not a “white” smile, but a lifelike one.
Outcome and long-term considerations
The final restorations restored proper tooth length, symmetry, and function while maintaining a natural, age-appropriate appearance. The gingival contours remain intact, the smile line is balanced, and the restorations blend in with the surrounding teeth.
Equally important, this approach preserved the patient’s natural teeth and avoided the added biological and esthetic risks associated with implants or bridges in the esthetic zone.
With proper maintenance and care, these restorations are designed to last many years while remaining serviceable, repairable, and biologically respectful.
Conclusion: conservative does not mean compromised
This case illustrates what is possible when orthodontics, restorative planning, and high-level ceramic craftsmanship are aligned.
Severe erosion does not automatically mean teeth are hopeless. With careful diagnosis, interdisciplinary collaboration, and attention to detail, it is often possible to preserve natural structures and achieve results that are both durable and beautiful.
The goal is not perfection.
The goal is dentistry that looks alive, functions naturally, and stands the test of time.
Case study 2 · Medically complex and cancer care
Fixed bridge after head and neck radiation: a 10-year result.
This case documents the conservative rehabilitation of a post-radiation patient referred from MD Anderson following treatment for tonsillar squamous cell carcinoma. Due to the biological limitations imposed by head and neck radiation, implants and extractions were avoided.
Through multidisciplinary periodontal management and precise restorative planning, a long-span porcelain-fused-to-zirconia fixed bridge was delivered.
The restoration has functioned comfortably and predictably for more than a decade, illustrating the value of biologically respectful, long-term treatment planning in medically complex cases.
- Patient concern
- Missing teeth and advanced gum disease after radiation for tonsil cancer (MD Anderson referral)
- Treatment
- Periodontal stabilization, then a long-span porcelain-fused-to-zirconia bridge
- Surgery/implants
- None
- Result
- Functioning comfortably for 10+ years
Treatments in this case: porcelain-fused-to-zirconia fixed bridge, gum disease control with a periodontist, and planning around osteoradionecrosis risk. Related: dental care for head and neck cancer, the dental exam before radiation, fluoride trays for radiation caries and dry mouth.
Initial presentation
This patient presented to our practice as a referral from MD Anderson Cancer Center following successful treatment for tonsillar squamous cell carcinoma. His cancer therapy included radiation to the head and neck region. While oncologic control was achieved, the long-term effects of radiation had significantly compromised his oral health.
At presentation, the patient had multiple missing teeth and advanced periodontal disease. The dentition was functionally unstable, and both hard and soft tissues were affected by prior radiation exposure. Chewing efficiency, comfort, and overall quality of life were diminished.
Previous evaluations had emphasized the limitations of treatment in the post-radiation patient. While the need for rehabilitation was clear, the path forward required careful consideration.
Clinical considerations and treatment philosophy
Dental rehabilitation after head and neck radiation demands a fundamentally different approach.
In post-radiation patients:
- Dental implants are generally not advisable due to the elevated lifetime risk of osteoradionecrosis.
- Tooth extractions should be avoided whenever possible, as healing is unpredictable and complications can be severe.
- Surgical intervention must be minimized in favor of conservative, biologically respectful solutions.
In this case, many conventional treatment options were eliminated before planning even began. The remaining teeth, though compromised, represented valuable biological assets that needed to be preserved rather than replaced.
Rather than pursuing extraction-based solutions, the treatment philosophy centered on stability, preservation, and long-term function.
Multidisciplinary planning and periodontal stabilization
A multidisciplinary approach was essential.
We worked closely with a trusted periodontist to address and stabilize the patient’s periodontal disease prior to any restorative intervention. The goal at this stage was not cosmetic improvement, but disease control: reducing inflammation, preserving remaining tooth structure, and establishing a foundation capable of supporting a definitive prosthesis.
Only after periodontal health was adequately managed did restorative planning proceed.
This collaborative approach allowed us to move forward conservatively, without introducing unnecessary surgical risk.
Restorative phase: precision in a compromised environment
The definitive restorative solution involved preparation of the remaining teeth for a long-span porcelain-fused-to-zirconia (PFZ) fixed bridge.
Long-span restorations in post-radiation patients present unique challenges. Occlusal tolerance is low, and even minor discrepancies can lead to discomfort, mechanical failure, or biological breakdown. For this reason, occlusion had to be exact.
Every step, from tooth preparation to bite registration to lab communication, was done with precision. Load distribution, connector design, and prosthetic contours were carefully engineered to support function while respecting the compromised biology of the supporting structures.
Outcome and long-term considerations
The final restoration restored functional chewing ability, stability, and comfort while maintaining a natural appearance appropriate to the patient’s age and facial structure.
Most importantly, the treatment respected the biological limitations imposed by prior radiation therapy.
This prosthesis has now been in continuous service for more than a decade, functioning predictably and comfortably. In medically complex cases, conservative planning and close teamwork with other specialists are what make that possible.
Conclusion: respecting biology yields longevity
This case illustrates that successful dental rehabilitation after head and neck radiation is not achieved by pushing boundaries, but by respecting them.
When treatment planning prioritizes preservation, stability, and precision, even patients with severely limited options can achieve durable, functional outcomes that meaningfully improve quality of life.
Case study 3 · Cosmetic and restorative
Bridge or implant for a cracked front tooth? A vertical root fracture case.
Is a bridge or an implant better for a front tooth? An implant is usually the first choice when there is enough healthy bone where the tooth was. When a fracture or infection has already destroyed that bone, or the teeth beside the gap need crowns anyway, a dental bridge is often the simpler, faster and more predictable way to replace a front tooth. This patient was that second case.
Her upper left front tooth (#9) had a vertical root fracture under an old crown, and the crack had already cost her a lot of bone. Instead of an implant that would have needed extensive bone grafting, we replaced teeth #8 through #11 with a porcelain-fused-to-zirconia bridge, carried to the canine for strength in her deep bite, and matched #6 and #7 in the same material. It took four visits over about two months in our privately owned, single-doctor practice in San Marco, Jacksonville. As Dr. Henley puts it, “We took an unfortunate situation and turned it into a masterpiece.” She loved it.
- Patient concern
- Keep her smile after losing a front tooth to a vertical root fracture
- Treatment
- Four-unit porcelain-fused-to-zirconia (PFZ) bridge from #8 to #11, plus PFZ veneers on #6 and #7
- Why not an implant
- Bone loss from the fracture would have made implant placement difficult
- Time
- 4 visits, about 2 months start to finish
Treatments in this case: extraction of the fractured tooth, a porcelain-fused-to-zirconia bridge, veneers and smile design. Related: dental bridge vs implant, cracked or broken teeth, dental implants and why do I need a crown?
Initial presentation
This patient came to our Jacksonville office because she was about to lose a front tooth. Her upper left central incisor (#9) had an old crown, and the root under it had a vertical fracture. It is one of the hardest kinds of cracked tooth to spot, because the crown on top can look fine while the root underneath is split.
A vertical root fracture usually cannot be repaired, and on a front tooth the answer is almost always extraction. The crack runs down the root, bacteria get in, and the bone around the tooth breaks down. By the time we saw her, the fracture had already caused significant bone loss around #9, which you can see on the x-ray.
The teeth next to it were part of the picture too. The crowns on her front teeth were a flat, opaque yellow, there were dark spaces near the gumline, and the teeth on her right side (#6 and #7) were a different shade. Her goal was simple: replace the tooth she was going to lose. Our goal was to do it so the whole smile looked better than before.
Bridge vs implant for a front tooth: why we chose a bridge
When a front tooth is lost there are two good ways to replace it: a dental implant or a fixed bridge. Dr. Henley places and restores implants in our office, so neither option is favored out of habit.
For her, the bone was the deciding factor. An implant needs enough bone to hold it, and the bone lost to the fracture would have made placing one a difficult process, likely with a bone graft, more surgery and more time before she had a finished front tooth. A bridge doesn’t depend on the bone where the tooth was. It is held by the teeth on either side, and the replacement tooth (the pontic) rests on the gum.
The neighboring teeth already needed new crowns, so a bridge also let one restoration fix the missing tooth and the old crowns at the same time. For the full comparison, including cost factors and how long each lasts, see our guide to a dental bridge vs implant.
Carrying the bridge to the canine for a deep bite
She has a deep bite, which means her lower front teeth close well up behind the upper ones and push on them every time she bites. A short bridge on two front teeth would take a lot of that force with very little support.
So the bridge runs from #8 to #11: her two front teeth, the left lateral incisor and the left canine. The canine has the longest root in the mouth, and including it spreads the load and gives the bridge the strength it needs for long-term stability. Zirconia is the material we trust for heavy bites for the same reason.
Why porcelain fused to zirconia
Front teeth have to be strong and look natural, and a porcelain-fused-to-zirconia (PFZ) bridge does both. The zirconia core gives it strength. Porcelain is layered over it by hand for color and translucency. There is no metal underneath, so there is no gray line at the gum.
The bridge and the two veneers were made by Paul Robert at Dynamic Dental Solutions, the lab we trust with front-tooth work.
Testing the smile in temporaries
Before anything permanent was made, she wore temporaries shaped like the planned final teeth. Temporaries do more than fill the gap. She gets to live with the new shape, length and shade, and we get to check her bite and speech before the lab makes the final work. Changes are easy at this stage and hard afterward.
Matching #6 and #7
A new bridge on her left next to older, darker teeth on her right would have traded one mismatch for another. So we prepared #6 and #7 (her right canine and lateral incisor) and covered them with porcelain-fused-to-zirconia veneers, made in the same material and shade as the bridge. All six front teeth that show when she smiles were designed and made together.
The result
The fractured tooth is replaced, the opaque crowns are gone, and her front teeth match from canine to canine in shade, shape and length. The bridge is anchored for her deep bite, and she never had to go through implant surgery on a site with this much bone loss.
She loved the result. Honest planning was what made the difference: choosing the option that fit her bone and her bite, not the one that sounds most advanced. You can see more results in our before and after gallery.
Frequently asked questions
Questions about these dental cases.
Can severely eroded teeth be saved without implants?
Often, yes. If the roots and remaining structure are healthy, orthodontics can restore proper spacing and proportions so the teeth can be crowned. That keeps the natural gum contours, which are very hard to recreate around implants in the front of the mouth.
Can you get dental implants after head and neck radiation?
Implants and extractions in irradiated bone carry a lifelong risk of osteoradionecrosis, so Dr. Henley generally favors non-surgical options such as fixed bridges built on the patient’s remaining teeth.
Is a bridge or an implant better for replacing a front tooth?
Both can work well. An implant needs enough healthy bone, and a fracture or infection can destroy a lot of it. When bone loss would make an implant difficult, or the teeth next to the gap already need crowns, a porcelain-fused-to-zirconia bridge is often the simpler and more predictable choice. Dr. Henley places and restores implants and makes bridges, so he can recommend whichever fits your bone and your bite.
Can a tooth with a vertical root fracture be saved?
Usually not. A vertical root fracture splits the root, lets bacteria in and causes bone loss, and on a front tooth it almost always means extraction. The tooth can then be replaced with an implant or a bridge, depending on how much bone is left. A crack caught early above the gumline is a different story and can often be saved; see cracked or chipped teeth.
Do you treat patients referred by cancer centers?
Yes. Dr. Henley sees patients referred by oncology teams before, during, and after head and neck radiation, typically within 72 hours of referral.
Do you offer second opinions on complex dental cases?
Yes. Many patients come to our San Marco office after being told a tooth or a smile can’t be saved, or after cosmetic work that never looked right. A comprehensive exam lets Dr. Henley explain every option, including keeping your own teeth when that is realistic.
Where can I see more before and after results?
Our before and after gallery shows more real patients from our Jacksonville office, with sliders you can drag to compare veneers, crowns, bonding and other treatment.
The goal is not aggressive intervention.
The goal is dentistry that works, and keeps working for years.
Complex dentistry near you
Complex and cosmetic dentistry in San Marco, Jacksonville.
All three cases were treated at our privately owned, single-doctor practice on Hendricks Avenue in San Marco. Patients come from across Jacksonville, including Mandarin, Southside, Riverside and Avondale, the Beaches, Ponte Vedra, Orange Park and St. Augustine, and patients in cancer treatment often travel here from farther away; see dental care while in Jacksonville for cancer treatment.
See what patients say in our reviews, or meet Dr. Henley.
Your next step
Talk with Dr. Henley about your case.
If you have been told your options are limited, bring your records and questions to a consultation. If a tooth has broken or hurts now, see emergency dental care.
CJ Henley, DMD, PA3675 Hendricks Avenue
Jacksonville, FL 32207
Prefer a nonurgent text? 904.762.5616 is our practice on-call and text line. Please don’t send sensitive health information by text, and call for anything urgent.