This patient initially presented for improving her upper arch crowding and uneven tooth wear, affecting her aesthetic appearance of the upper ach: colour, worn teeth. The orthoodntic treatment was not an options at this stage for her.
Treatment: 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 to complement facial aesthetics of this lovely patient.
This study will show:
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:
Diagnosis: Unacceptable tooth an 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 – 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:
Now you have preferred template.
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.
Following with discussion of all risks and treatment modalities with our patient that included:
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.
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