Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Patient1

711 views

Published on

  • Be the first to comment

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

×