Initial Presentation

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:

1. To improve the general discolouration, tooth shape, shade and form and improve the arch width.
2. This lovely socilite patient wants to smile, understanding the complexity and the precison of the work required.

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

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.

Treatment

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

1. No treatment: this is not an option as we have considerable discolouration and enamel loss from acidic diet
2. Repair existing restorations and gum lift: this is a temporary measure and not accepted by the patient
3. Porcelain veneers / onlays: best long-term solution, Fixed option: accepted 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 12 maxillary teeth porcelain veneers.

This was accomplished with minimal discomfort to the patient and using no tooth intervention.

Procedure & Results

1. Diagnostic: mock-up and assessment. Finalise degree of gum and teeth showing during smile and speech dynamics, maxillary arch form and smile width
2. Impressions for porcelain veneers
3. Lower arch tooth in-house whitening
4. Issue the porcelain veneers

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!