Initial presentation

Smile rejuvenation with improvement in level of tooth display with construction of maxilla (upper arch) using composite veneers to improve: tooth shape, colour, display, arch form and shape. The reason for using composite veneers was to have the option in considering orthodontic treatment in the future, if required. This is a minimal intervention aesthetic treatment, where the tooth basically remains intact. Ideally, orthodontic levelling and restorative correction is the best option. However it is not an option for her.

My chief concerns: improving the aesthetic appearance of her smile:

1. To improve the smile, upper arch shape and worn smile line as well as tooth colour.
2. This lovely socilite patient wants to smile understanding the complexity and the precison of the work required.

Diagnosis: Unacceptable tooth an gum display, assymetry and narrow upper arch: creating an aesthetic disturbance.

Diagnosis & Patient centred treatment planning

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 – Real Smile Design™. Finalise degree of gum and tooth showing during smile and speech dynamics, maxillary arch form and smile width. The spaces are closed. We tested the diagnostic mock up for patient acceptance that guided for final desired aesthetic outcome. We assess:

• Smile dynamics
• Speech dynamics
• Functional envelope

Now you have preferred template.

1. Smile line
2. Tooth shape and form.
3. Level of tooth display.
4. Gum symmetry and tooth emergence profile.
5. Occlusal scheme creating/improving excursive movements.
6. Assessment of speech, comfort and bite level.
7. Assessment of lip support, outline and symmetry.
8. Accepted patient assessment of speech and smile dynamics: ideal consenting process by the patient who can assess every detail in 3D in her own mouth, without any laboratory step or costing.
9. REAL SMILE DESIGN™ Digital Smile Design is totally irreverent here.

Finalise degree of gum and tooth showing during smile and speech dynamics, maxillary arch form and smile width. The spaces are closed with natural tooth formation. 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 direct composite veneers. This was accomplished with minimal discomfort to the patient and using no tooth intervention and required no tooth intervention. Therefore, the tooth enamel is left intact.

Treatment

Following with discussion of all risks and treatment modalities with our patient that included:

1. No treatment: this is not an option since the patient is most concerned about spaces: affecting aesthetics
2. Composite additions: this could work but this is a temporary measure and not accepted by the patient
3. Orthodontic closing of the spaces: this could make the upper arch narrower, further complicating aesthetics: not accepted by the patient
4. Dental veneers: best long-term solution: accepted by the patient

Procedure & Results

1. Finalise degree of gum and tooth showing during smile & speech dynamics, maxillary arch form and smile width
2. Direct composite veneers

Composite veneers on ten upper teeth: note the change in colour, length and shape of the teeth. The work was completed in one visit. Note symmetry and harmony. We tested the diagnostic mock up for patient acceptance that guided for final desired aesthetic outcome. Final treatment outcome: we have restored aesthetics.

5 Years Post Op
5 Years later mandible (lower jaw): Request for Orthodontic correction. Composite veneers upper arch and orthodontics in the lower arch: creating balance.

10 Years Post Op
Aesthetic effect should establish harmony and balance between dentition and surrounding soft tissues. Final treatment outcome and we have a happy patient. However, most importantly we have complemented our lovely patient’s facial aesthetics.