This patient initially presented for an improvement in aesthetic appearance of her upper arch. As you can see we have considerable recession of gums and general tooth discolouration. The front crowns have been placed for some time. However, with time all restorations do breakdown and although over the years we have repaired these teeth, the patient felt that it was time to replace the restorations properly and get the smile right.
The patient has a high gummy smile and general restorations and tooth discolourations is a concern her.
Treatment: Smile rejuvenation with improvement in level of tooth display by maintaining gum levels and construction of maxilla (upper arch) using tooth and implant supported crowns to improve: tooth shape, colour, display, arch form and shape to compliment facial aesthetics of this lovely patient.
This study will show:
Now we have a unique opportunity to improve on the diagnosis and design of proposed treatment plan: The difficulty here is the deciding the level of tooth and gum display required and to create that youthfulness, while maintaining natural colours for this elegant and delightful patient.
In this case the diagnosis was both intraoral and, on the study-models mounted in the articulator to be able to simulate and execute the treatment plan. Since it is critical in formulating how we design these restorations for an optimal aesthetic and functional outcome. The good thing is that we have good gum and lip symmetry across the facial midline as this simplifies the restorative design. Implants will be placed in the correct 3D position to facilitate planned aesthetic outcome.
High smile line, gum recessions, discoloured teeth & restorations
Chief concerns: improving the aesthetic appearance of her smile:
Diagnosis: Unacceptable tooth and gum display, assymetry and narrow upper arch: creating an aesthetic disturbance
Once we have determined their needs and expectations and when the patient is ready, we begin to restore their teeth to optimal function and aesthetics.
Diagnostic: mock-up and assessment. Finalise the degree of gum and teeth showing during smile and speech dynamics, maxillary arch form and smile width. This was complimented by the provisional crowns.
We tested the diagnostic mock up for patient acceptance which guided the final desired aesthetic outcome.
Provisional crowns helped initial assessment process and were further modified and approved by the patient.
Our Aim: to improve the aesthetics of upper arch: Gum level, tooth shape, display, tooth colour, length, symmetry and smile line in general along the upper arch involving 10 maxillary teeth.
This was accomplished with minimal discomfort to the patient. Provisional crowns helped initial assessment process and were further modified and approved by the patient, for that ultimate aesthetic outcome.
Following with discussion of all risks and treatment modalities with our patient that included:
The work was completed in two visits. In general it takes about 3-4 weeks from diagnosis to final outcomes.
I would prefer 3 weeks for gum healing. Is best not to rush biology and allow optimal healing
We tested the diagnostic mock up for patient acceptance that guided thr final desired aesthetic outcome.
Creating balance and complementing on facial aesthetics: confidence
The aesthetic effect should establish harmony and balance between dentition and surrounding soft tissues. Note how all compositional elements of teeth gums lips and face are in concert together
Hence the term: dentofacial rejuvenation. However, most importantly we have complemented our lovely patient’s facial aesthetics.
Final treatment outcome and we have a confident and happy patient.
Thank you for taking the time to explore this patient’s story. I hope this gives you an idea of what I can do for you if you are having difficulty and need help, because there is always hope.
Dr. Sarkis Nalbandian
Visiting Professor YSMU
Specialist Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London
D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth) FIADE, FPFA