before after

This case as you will see addressed all aesthetic challenges possible in our profession. We find in everyday modern day dentistry implants although better suited are sometimes not always the best solution. With this patient factors to consider were:-

already had 20 years of functionally successful bridge-work in the upper arch had explored implants but due to high smile line we could not guarantee an aesthetic result as the

tissue defects were large please consider tissue colour in this case as it does vary from one photo to the next and you will see

that in fact in the posterior left hand quadrant of the upper arch with little light the tissue photographs better but in the upper right hand quadrant in the anterior region tissue colour varies in the photographs but on the whole is a good match

there would be a compromise on contour in the anterior tissue region to accommodate for hygiene and cleaning

material used for this case include:-

Renishaws’™ zirconia single units and bridge units GC Gradia™ soft tissue replacement Vita VM9™ zirconia porcelain

before treatment

before treatmentupper and lower teeth

frontal view1:2 magnificationnaturally retracted gingival display

Teeth to be replaced 16, 15, 14, 13, 12 and 11, in one zirconia bridge 21 and 22 single zirconia units

23, 24, 25, 26 and 27 in another zirconia bridge (these bridges were milled in Renishaws’™ material)

note the:-

deficiency of tissue around 11, 12, 13 and 14 deficiency of tissue around 26

irregularity of gingival heights

before treatmentupper anterior teeth

left lateral view1:2 magnificationnaturally retracted gingival display

teeth to be replaced 16, 15, 14, 13, 12 and 11, in one zirconia bridge

note the:-

emergence profile shows the need for tissue contouring and replacement

incisal edge contours and incisal lengths too long

before treatmentmaxillary anterior teeth

right lateral view 1:2 magnificationnaturally retracted gingival display

note the:-

emergence profile helps as a visual reference for labial face facets

incisal edge contours and incisal lengths and irregular gum heights

before treatmentmaxillary anterior teeth

1:2 magnificationfrontal view

retracted

before treatmentmaxillary arch

occlusal view 1:2 magnification

note the:-

tissue defect and span of bridges

during treatmentgauging occlusal orientation

1:1 magnificationnon-retracted

during treatmentupper and lower teeth

frontal diagnostic try-in, in-situ view1:1 magnificationnaturally retracted gingival display

translating diagnostic in the mouth showing incisal curve, without contrasting device

note that:-

how the cant of the anteriors was duplicated from the orange stick and putty

decided to perform gingivectomies on 21, 22 and the pre-molars to improve gum smile line

this also allows us to lift the occlusal table and reduce

crown length to width ratio of the centrals

made temporaries from diagnostic that was done on the preps themselves

one month after proper treatmentupper and lower anterior teeth

frontal view 1:2 magnificationnaturally retracted gingival display

note that:-

we aimed for the Golden Rule tested patients tissue tolerance and ability to clean at this

stage

gingivectomy performed

before treatmentmandibular anterior teeth

lateral view 1:4 magnification

Vita 3-D™ 1M1 tab without contrasting device

note the:-

value showing contrast to the natural teeth clearly

before treatmentlower teeth

frontal view1:4 magnificationretracted

Vita 3-D™ 2M2 tab without contrasting device

note the:-

correct value

during treatment

lateral view1:4 magnificationretracted

taking tissue colour for composite tissue replacement

during treatment

lateral view1:4 magnificationretracted

taking tissue colour for composite tissue replacement

three months after proper treatmentmaxillary anterior teeth

frontal view1:2 magnificationretracted

bridges and crowns in place with gingival display

note the:-

final emergence profiles of the crowns 21and 22 21 and 22 had to be slightly bigger to fill the space between

vital 23 and mid-line

23 is a bridge anchor

before treatmentupper anterior teeth

left lateral view1:2 magnificationnaturally retracted gingival display

teeth to be replaced 16, 15, 14, 13, 12 and 11, in one zirconia bridge

note the:-

emergence profile shows the need for tissue contouring and replacement

incisal edge contours and incisal lengths too long

after treatmentmaxillary anterior teeth

right lateral view 1:2 magnificationnaturally retracted gingival display

note the:-

emergence profile soft tissue replacement above 25 and 26

23, 24, 25, 26 and 27 are a bridge

incisal edge contours and incisal lengths and irregular gum heights are corrected

after treatmentupper and lower teeth

frontal view1:2 magnificationretracted gingival display

teeth to be replaced are 16, 15, 14, 13, 12 and 11, in one zirconia bridge 21 and 22 single zirconia units

23, 24, 25, 26 and 27 in another zirconia bridge (these bridges were milled in Renishaws’™ material

note the:-

papilla reduction in crown length by 3mm

smile line

regularity of gingival heights

after treatment