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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
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