Patient1

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Patient1

  1. 1. Patient 1
  2. 2. * female * medical condition: none * patient’s request - get rid of her pain in the her upper anterior teeth and she wants to get her “old” smile back (referred patient) * 30 years Patient 1
  3. 3. history: crown lengthening after 6 porcelain restoration have been placed.
  4. 4. Digital Facebow November 2010 Facial Analysis
  5. 5. Facial Analysis
  6. 6. Facial Analysis
  7. 7. Facial Analysis Lips in Repose +/- 4 mm tooth structure
  8. 8. Facial Analysis Full Smile Lip Dynamics WNL
  9. 9. Dental Analysis 21 rootcanal (due to pain) 13 mm 8.3 mm
  10. 10. x-ray’s
  11. 11. initial periodontal chart
  12. 12. Diagnosis * iatrogenic damage to soft tissue and teeth (13-23): violation of biologic width resulting in crown lengthening * leakage ceramic restorations (bacteria) causing soft tissue inflammation * gummy smile * long anterior teeth upper jaw * To much tooth exposure with lips in repose / dynamic interference anterior teeth with lower lip during smiling * buccal corridor in conflict with anterior region
  13. 13. primary concerns * how to eliminate the pain in her teeth * How to “heal” the affected soft tissue * How to re-establish correct tooth proportions * How to restore her teeth long term * How to meet her aesthetic wishes (want “old smile” back)
  14. 14. treatment objectives * re-create healthy soft tissue around the restorations * improve length-width ratio’s of her upper anterior teeth * improve the aesthetics of her smile * eliminate pain * improve soft tissue positions (facially) of tooth 13-23
  15. 15. treatment plan * remove old ceramic restorations * cement provisionals (13-23) with the correct l/w ratio * re-create a new CEJ position restoratively * soft tissue healing phase * root coverage with Allograft (alloderm) using the tunnel technique * healing and maturation phase soft tissue (6 months) * ceramic restorations 13-23
  16. 16. November 2010
  17. 17. March 2012 1.5 years after placement provisionals Re- established tooth contour (CEJ-form)
  18. 18. March 2012 Re- established tooth contour Cemento-restorative margin Miller Class I
  19. 19. periodontal re-evaluation
  20. 20. x-ray re-evaluation
  21. 21. Oktober 2013 Soft Tissue levels alterations Tunnel Technique with Alloderm
  22. 22. S h a d e
  23. 23. Smile Evaluation
  24. 24. re-evaluate provisionals (3 years in function)
  25. 25. Try inn Ceramic Restorations
  26. 26. 4 years after start treatment
  27. 27. X-Photo examination
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