The main concern for this patient “Mr T” was the position of the upper arch of teeth in his face, making his face “sunken in”. This was a result of a past orthodontic treatment, where the orthodontist had tried to create “straight teeth”. However, contrary to popular belief: straight teeth do not always make beautiful smiles.
My treatment for this patient included a smile rejuvenation with improvement in level of teeth display and position of the upper arch of teeth (maxilla) using additive smile rejuvenation as I was building the arch form wide.
Porcelain veneers, in this patient’s case, improved the tooth shape, colour, display, arch form and shape to complement his facial aesthetics.
This study will show;
The patient had this work completed in my practice some 15 years ago. However with time the restorations required revisiting. He was a past smoker, stopped now for 2 years. I now have a unique opportunity to improve on the diagnosis and design of proposed treatment plan with the patient.
The difficulty here was the extent of his teeth arch positioning and tooth form required. Therefore the direct diagnostic composite mock was critical for us in formulating how we design these restorations for an optimal aesthetic outcome for him. To improve the the gummy smile, narrow upper teeth arch shape and smile line as well as tooth colour/shade selection. This lovely socialite patient wants to smile with confidence and understands the complexity and the precision of the work required.
Once I have determined their needs and expectations and when the patient is ready, I begin to restore their teeth to optimal function and aesthetics.
My diagnosis in this case: Unacceptable arch position, and tooth and narrow upper arch – creating an aesthetic disturbance
As a specialist, my role is critical in the diagnosis and treatment planning for optimal patient centered outcome. The most important part of this is the diagnosis and the diagnostic mock-up in this case.
In this dignostic mock-up and assessment the patient and I finalise the degree of gum and teeth showing during smile, speech dynamics and how the teeth will affect speech, maxillary teeth arch form and smile width.
The diagnostic mock up for patient was tested and accepted and that guided me for his final desired aesthetic outcome.
My aim was to improve the aesthetics of upper arch: Gum level, tooth shape, display, teeth 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 without cutting the patients teeth. No provisional veneers were required. Therefore, the tooth enamel is intact and helped in gum healing process following the gum lift.
I discussed all risks and treatment modalities with my patient that included:
The work for this patient was completed in two visits. In general it takes about 2 weeks from diagnosis to final outcomes.
The porcelain veneers by the Designer Smiles™ technical team created balance and complemented the facial aesthetics. The patient’s confidence was improved and he was very happy with the dento-facial rejuvenation.
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