before                        after

This case as you will see addressed all aesthetic challenges possible in our professi...
before treatment
upper and lower teeth

frontal view
1:2 magnification
naturally retracted gingival display

Teeth to be r...
before treatment
upper anterior teeth

left lateral view
1:2 magnification
naturally retracted gingival display

teeth to ...
before treatment
         maxillary anterior teeth

         1:2 magnification
         frontal view

         retracted

...
during treatment
gauging occlusal orientation

1:1 magnification
non-retracted




during treatment
upper and lower teeth
...
•   made temporaries from diagnostic that was done on the
       preps themselves



one month after proper treatment
uppe...
before treatment
lower teeth

frontal view
1:4 magnification
retracted

Vita 3-D™ 2M2 tab without contrasting device

note...
during treatment

lateral view
1:4 magnification
retracted

taking tissue colour for composite tissue replacement




thre...
before treatment
upper anterior teeth

left lateral view
1:2 magnification
naturally retracted gingival display

teeth to ...
after treatment
  upper and lower teeth

  frontal view
  1:2 magnification
  retracted gingival display

  teeth to be re...
Case study of the month
Case study of the month
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Case study of the month

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Transcript of "Case study of the month"

  1. 1. before after This case as you will see addressed all aesthetic challenges possible in our profession. We find in everyday modern day dentistry implants although better suited are sometimes not always the best solution. With this patient factors to consider were:- • already had 20 years of functionally successful bridge-work in the upper arch • had explored implants but due to high smile line we could not guarantee an aesthetic result as the tissue defects were large • please consider tissue colour in this case as it does vary from one photo to the next and you will see that in fact in the posterior left hand quadrant of the upper arch with little light the tissue photographs better but in the upper right hand quadrant in the anterior region tissue colour varies in the photographs but on the whole is a good match • there would be a compromise on contour in the anterior tissue region to accommodate for hygiene and cleaning material used for this case include:- • Renishaws’™ zirconia single units and bridge units • GC Gradia™ soft tissue replacement • Vita VM9™ zirconia porcelain before treatment
  2. 2. before treatment upper and lower teeth frontal view 1:2 magnification naturally retracted gingival display Teeth to be replaced 16, 15, 14, 13, 12 and 11, in one zirconia bridge 21 and 22 single zirconia units 23, 24, 25, 26 and 27 in another zirconia bridge (these bridges were milled in Renishaws’™ material) note the:- • deficiency of tissue around 11, 12, 13 and 14 • deficiency of tissue around 26 • irregularity of gingival heights
  3. 3. before treatment upper anterior teeth left lateral view 1:2 magnification naturally retracted gingival display teeth to be replaced 16, 15, 14, 13, 12 and 11, in one zirconia bridge note the:- • emergence profile shows the need for tissue contouring and replacement • incisal edge contours and incisal lengths too long before treatment maxillary anterior teeth right lateral view 1:2 magnification naturally retracted gingival display note the:- • emergence profile helps as a visual reference for labial face facets • incisal edge contours and incisal lengths and irregular gum heights
  4. 4. before treatment maxillary anterior teeth 1:2 magnification frontal view retracted before treatment maxillary arch occlusal view 1:2 magnification note the:- • tissue defect and span of bridges
  5. 5. during treatment gauging occlusal orientation 1:1 magnification non-retracted during treatment upper and lower teeth frontal diagnostic try-in, in-situ view 1:1 magnification naturally retracted gingival display translating diagnostic in the mouth showing incisal curve, without contrasting device note that:- • how the cant of the anteriors was duplicated from the orange stick and putty • decided to perform gingivectomies on 21, 22 and the pre- molars to improve gum smile line • this also allows us to lift the occlusal table and reduce crown length to width ratio of the centrals
  6. 6. • made temporaries from diagnostic that was done on the preps themselves one month after proper treatment upper and lower anterior teeth frontal view 1:2 magnification naturally retracted gingival display note that:- • we aimed for the Golden Rule • tested patients tissue tolerance and ability to clean at this stage • gingivectomy performed before treatment mandibular anterior teeth lateral view 1:4 magnification Vita 3-D™ 1M1 tab without contrasting device note the:- • value showing contrast to the natural teeth clearly
  7. 7. before treatment lower teeth frontal view 1:4 magnification retracted Vita 3-D™ 2M2 tab without contrasting device note the:- • correct value during treatment lateral view 1:4 magnification retracted taking tissue colour for composite tissue replacement
  8. 8. during treatment lateral view 1:4 magnification retracted taking tissue colour for composite tissue replacement three months after proper treatment maxillary anterior teeth frontal view 1:2 magnification retracted bridges and crowns in place with gingival display note the:- • final emergence profiles of the crowns 21and 22 • 21 and 22 had to be slightly bigger to fill the space between vital 23 and mid-line • 23 is a bridge anchor
  9. 9. before treatment upper anterior teeth left lateral view 1:2 magnification naturally retracted gingival display teeth to be replaced 16, 15, 14, 13, 12 and 11, in one zirconia bridge note the:- • emergence profile shows the need for tissue contouring and replacement • incisal edge contours and incisal lengths too long after treatment maxillary anterior teeth right lateral view 1:2 magnification naturally retracted gingival display note the:- • emergence profile • soft tissue replacement above 25 and 26 • 23, 24, 25, 26 and 27 are a bridge incisal edge contours and incisal lengths and irregular gum heights are corrected
  10. 10. after treatment upper and lower teeth frontal view 1:2 magnification retracted gingival display teeth to be replaced are 16, 15, 14, 13, 12 and 11, in one zirconia bridge 21 and 22 single zirconia units 23, 24, 25, 26 and 27 in another zirconia bridge (these bridges were milled in Renishaws’™ material note the:- • papilla • reduction in crown length by 3mm • smile line • regularity of gingival heights after treatment
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