Patient 4
Patient 4
* female
* 42 years old
* no medical condition
*patient’s request:
improvement of the
aesthetics of her upper
an...
Facial Analysis
2-3 mm tooth structure visible with lips in repose
Facial Midline
=
Lay people did not detect a
midline deviation up to 4mm, if
parallel to the facial midline
Dental midline...
Upper Lip Mobility
A non-hyperactive lip moves approximately 6-8 mm
from resting position to a broad smile
on the other ha...
Facial Analysis
Dental Examination
Dental Examination
1.0
0.8
Dental Examination (perio)
Dental Examination (x-ray)
Diagnosis
- excessive gingival display due to hyper active upper lip
- overcontoured composite restorations (to mask tetra...
Treatmentplan
- re-contour lower anterior composite restorations for soft tissue healing
- replace composite restorations ...
Dental Examination (old photo’s)
Dental Examination (planning)
Dental Examination (planning)
Over-contoured composite
restorations
Dental Examination (wax-up)
Dental Examination (planning/wax-up)
adjusted anatomy central
incisors
Dental Examination (planning)
Preparation guide (silicone)
Check preparation design (not enough reduction)
Check preparation designCheck preparation design (enough reduction)
Preparations
Shade communication with ceramist
Preparations (VPS impression)
Evaluation of the Provisionals
Ceramic Restorations
Rubberdam Isolation
Rubberdam Isolation
Final Result
before… …. after
Final Result
Final Result
Final Result
Dental Examination (x-ray)
Follow up
patient was happy with her treatment and want
the same treatment on her lower anterior teeth
(that will be finis...
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Patient 4

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Patient 4

  1. 1. Patient 4
  2. 2. Patient 4 * female * 42 years old * no medical condition *patient’s request: improvement of the aesthetics of her upper anterior teeth They are restored with composite to mask tetracycline discolourations * referred patient
  3. 3. Facial Analysis 2-3 mm tooth structure visible with lips in repose
  4. 4. Facial Midline = Lay people did not detect a midline deviation up to 4mm, if parallel to the facial midline Dental midline 1.5 mm to the right
  5. 5. Upper Lip Mobility A non-hyperactive lip moves approximately 6-8 mm from resting position to a broad smile on the other hand a hyperactive upper lip moves a distance of 1.5 to 2 times greater Upper Lip Mobility: 10 mm
  6. 6. Facial Analysis
  7. 7. Dental Examination
  8. 8. Dental Examination 1.0 0.8
  9. 9. Dental Examination (perio)
  10. 10. Dental Examination (x-ray)
  11. 11. Diagnosis - excessive gingival display due to hyper active upper lip - overcontoured composite restorations (to mask tetracycline discolouration) - crowding lower anterior teeth - crowding lower anterior teeth (compensated with composite restorations) - over eruption 31 and 41 - gingivan inflamation bucally lower anterior teeth
  12. 12. Treatmentplan - re-contour lower anterior composite restorations for soft tissue healing - replace composite restorations upper anterior (14-25) with provisional restorations with improved anatomical form - evaluate function and aesthetics - replace provisonal restorations with ceramic restorations - recontour lower anterior teeth to functional patterns
  13. 13. Dental Examination (old photo’s)
  14. 14. Dental Examination (planning)
  15. 15. Dental Examination (planning) Over-contoured composite restorations
  16. 16. Dental Examination (wax-up)
  17. 17. Dental Examination (planning/wax-up) adjusted anatomy central incisors
  18. 18. Dental Examination (planning)
  19. 19. Preparation guide (silicone)
  20. 20. Check preparation design (not enough reduction)
  21. 21. Check preparation designCheck preparation design (enough reduction)
  22. 22. Preparations
  23. 23. Shade communication with ceramist
  24. 24. Preparations (VPS impression)
  25. 25. Evaluation of the Provisionals
  26. 26. Ceramic Restorations
  27. 27. Rubberdam Isolation
  28. 28. Rubberdam Isolation
  29. 29. Final Result before… …. after
  30. 30. Final Result
  31. 31. Final Result
  32. 32. Final Result
  33. 33. Dental Examination (x-ray)
  34. 34. Follow up patient was happy with her treatment and want the same treatment on her lower anterior teeth (that will be finished in september 2014)

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