Patient 6

Patient 6

* male

* 61 years

* patient’s request: - Improvement of the esthetics of the teeth in the upper jaw !- natural looking but color little bit brighter

* medical condition: - thrombosis - medication: anti-coangulant

Facial Analysis

Digital Facebow

Facial Analysis

Facial Analysis

excessive anterior gingival display

anterior gummy smile

extra-oral examination

* horizontal and vertical reference lines: !- with in normal limits - facial = dental midline (1/2 mm to the right) !* in the anterior maxilla extended soft-tissue display

Facial Analysis Lips in Repose

+/- 3 mm tooth structure

Facial Analysis Full Smile

Lip Dynamics WNL

Facial Analysis Full Smile

Anterior Gummy Smile

Dental Analysis

8 mm9 mm

envelope of function??

Dental Analysis Wear

Dental Analysis

Dental Analysis Function

no tender muscles, no joint problems

FunctionDental Analysis

Dental Analysis Function

Central incisors retroclined

intra-oral examination:

composite restoration metal ceramic crown

C e n t r i c

R e l a t i o n

possibility to open the envelope of function

intra-oral examination/study cast:cro = mip

radiographic examination

radiographic examination

periodontal examination

constricted envelope of function due to loss of anatomical form of teeth / parafunction (airway issue?)

diagnosis

anterior gummy smile due to dental alveolar eruption af anterior teeth

recessions due to abrasion

short anterior teeth (12-22)

recessions due to abrasion

what are the patient’s financial constraints? for now treatment limited to the upper jaw

how could we satisfy the patient’s aesthetic and functional concerns?

should we add to the incisal edges to lengthen the anterior teeth? If so should we open the vdo?

Is the patient willing to go through orthodontic treatment, periodontal surgery or to manage teeth restoratively?

how to manage the amount of wear?

primary concerns

how to create better length/width ratio’s on the upper anterior teeth

can we restore this patient predictably with long-term strategy?

protect remaining teeth from wear/open envelope op function

restore a stable occlusion in centric related occlusion with anterior guidance

satisfy aesthetic concerns

develop long term-strategy

treatment objectives

provisional restoration phase of 3 months to check, biology, function and aesthetics

treatment plan

replace old composites for new ones

adjust occlusion to create cro = mip

prep teeth (backwards planning) and restore with provisional restorations to try out aesthetics adjustments, function and phonetics

copy provisionals to ceramic restorations

re-evaluate provisionals

night guard

maintenance program

functional/aesthetic wax-up in centric relation

functional/aesthetic wax-up in centric relation

wax-up used for a preparation guide

“minimal invasive”

provisional restorations (chair side made)

test aesthetics, function, phonetics with the provisional restorations (chair side made)

Light Transmission

Adhesive Techniques

Try-in ceramics

Final Result

Final Result

20 Month Result

radiographic follow up

5 Year Result