This patient presented with considerable enamel loss in the upper arch at such a young age. A high smile with general discolouration has been a major concern for her
reatment: Smile rejuvenation
The aim was to improve the display of maxilla (upper arch) using porcelain veneers to improve: tooth shape, colour, display, arch form and shape to complement facial aesthetics of this lovely patient.
This study will show:
Patient is in public relations, healthy fit and happy. Dietary acidity has resulted in extensive loss of enamel. The discolouration is due to dentine showing through remaining thin enamel.
Now we have a unique opportunity to improve on the diagnosis and design of proposed treatment plan. The difficulty here is minimal enamel present and the degree of discolouration (due to dark dentine showing through the thin enamel) and extent of the smile line: wide smile and display if 12 upper and lower teeth during smile and speech dynamics.
Therefore, the direct diagnostic composite mock-up is critical in formulating how we design these restorations for an optimal aesthetic outcome.
Chief concerns: improving the aesthetic apperance of her smile:
Diagnosis: Unacceptable tooth colour display, and narrow upper arch: creating an aesthetic disturbance
Enamel loss in the upper arch at such a young age. Note the translucent enamel present. She has lost about 3mm of enamel.
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 and assessment. Finalise degree of teeth showing during smile and speech dynamics, maxillary arch form and smile width.
We tested the diagnostic mock-up for patient acceptance that guided the final desired aesthetic outcome.
Following a discussion of all risks and treatment modalities with our patient that included:
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.
The work was completed in two visits. In general it takes about 3 weeks from diagnosis to final outcomes.
We tested the diagnostic mock up for patient acceptance that guided the final desired aesthetic outcome.
Porcelain veneers creating balance and complimenting facial aesthetics: confidence. Note how all compositional elements of teeth gums lips and face are in concert together. Aesthetic effect should establish harmony and balance between dentition and surrounding soft tissues.
It’s always enjoyable to take images of this delightful patient. Most photogenic and always smiling!
Final treatment outcome: we have restored aesthetics comfort and function. However most importantly we have complemented our lovely patient’s facial aesthetics. Hence the term: dentofacial rejuvenation. 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