Initial Presentation

Patient has this work completed in the practice some 15 years ago. However with time the restorations required revisiting.

Past smoker, stopped now for 2 years.

Now we have a unique opportunity to improve on the diagnosis & design of proposed treatment plan:

The difficulty here is the gum pigmentation that is present with the proposed tooth length using combination of gum lift and porcelain veneers. Therefore the direct diagnostic composite mock is critical in formulating how we design these restorations for an optimal aesthetic outcome.

Chief concerns: improving the aesthetic apperance of her smile:

• To improve the the gummy smile, narrow upper arch shape and smile line as well as tooth colour.
• 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

Diagnostic: mock-up & assessment. Finalise degree of gum and tooth showing during smile & speech dynamics, maxillary arch form & smile width.
We tested the diagnostic mock up for patient acceptance that guided for final desired aesthetic outcome.

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 12 maxillary teeth porcelain veneers.

This was accomplished with minimal discomfort to the patient and using no tooth intervention. No provisional veneers were required, since he existing composite veneers placed by the author 15 years ago required no tooth intervention. Therefore, the tooth enamel is intact and helped in gum healing process following gum lift. (Please refer to Videos provided).

Treatment

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

1. No treatment: this is not an option as the restorations are failing and affecting aesthetics
2. Repair existing restorations and gum lift: this is a temporary measure and not accepted by the patient
3. Gum lift & porcelain veneers: best long-term solution, Fixed option: accepted by the patient.

Procedure & Results

1. Diagnostic: mock-up & assessment. Finalise degree of gum and tooth showing during smile & speech dynamics, maxillary arch form & smile width
2. Removal of existing composite veneers & gum lift
   Impressions for porcelain veneers
3. Issue the porcelain veneers

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 for final desired aesthetic outcome.

Gum Lift & porcelain veneers
Creating balance and complementing on facial aesthetics: CONFIDENCE
Note how all compositional elements of teeth gums lips and face are in concert together
The Aesthetic Effect: Should establish harmony and balance between dentition and surrounding soft tissues

Final treatment outcome: we have restored aesthetics.
However most importantly we have complemented our lovely patient’s facial aesthetics.
Hence the term: dentofacial rejuvenation by Dr Sarkis Nalbandian

The Aesthetic Effect

Should establish harmony and balance between dentition and surrounding soft tissues

Final treatment outcome and we have a happy patient

Final treatment outcome: we have restored aesthetics comfort & function.

However most importantly we have complemented our lovely patient’s facial aesthetics.

Hence the term: dentofacial rejuvenation by Dr Sarkis Nalbandian