Patient 6

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Patient 6

  1. 1. Patient 6
  2. 2. Patient 6 * male * 61 years * patient’s request: - Improvement of the esthetics of the teeth in the upper jaw ! - natural looking but color little bit brighter * medical condition: - thrombosis - medication: anti-coangulant
  3. 3. Facial Analysis Digital Facebow
  4. 4. Facial Analysis
  5. 5. Facial Analysis excessive anterior gingival display anterior gummy smile
  6. 6. extra-oral examination * horizontal and vertical reference lines: ! - with in normal limits - facial = dental midline (1/2 mm to the right) ! * in the anterior maxilla extended soft-tissue display
  7. 7. Facial Analysis Lips in Repose +/- 3 mm tooth structure
  8. 8. Facial Analysis Full Smile Lip Dynamics WNL
  9. 9. Facial Analysis Full Smile Anterior Gummy Smile
  10. 10. Dental Analysis 8 mm 9 mm envelope of function??
  11. 11. Dental Analysis Wear
  12. 12. Dental Analysis
  13. 13. Dental Analysis Function no tender muscles, no joint problems
  14. 14. FunctionDental Analysis
  15. 15. Dental Analysis Function Central incisors retroclined
  16. 16. intra-oral examination: composite restoration metal ceramic crown
  17. 17. C e n t r i c R e l a t i o n possibility to open the envelope of function intra-oral examination/study cast: cro = mip
  18. 18. radiographic examination
  19. 19. radiographic examination
  20. 20. periodontal examination
  21. 21. constricted envelope of function due to loss of anatomical form of teeth / parafunction (airway issue?) diagnosis anterior gummy smile due to dental alveolar eruption af anterior teeth recessions due to abrasion short anterior teeth (12-22) recessions due to abrasion
  22. 22. what are the patient’s financial constraints? for now treatment limited to the upper jaw how could we satisfy the patient’s aesthetic and functional concerns? should we add to the incisal edges to lengthen the anterior teeth? If so should we open the vdo? Is the patient willing to go through orthodontic treatment, periodontal surgery or to manage teeth restoratively? how to manage the amount of wear? primary concerns how to create better length/width ratio’s on the upper anterior teeth can we restore this patient predictably with long-term strategy?
  23. 23. protect remaining teeth from wear/ open envelope op function restore a stable occlusion in centric related occlusion with anterior guidance satisfy aesthetic concerns develop long term-strategy treatment objectives provisional restoration phase of 3 months to check, biology, function and aesthetics
  24. 24. treatment plan replace old composites for new ones adjust occlusion to create cro = mip prep teeth (backwards planning) and restore with provisional restorations to try out aesthetics adjustments, function and phonetics copy provisionals to ceramic restorations re-evaluate provisionals night guard maintenance program
  25. 25. functional/aesthetic wax-up in centric relation
  26. 26. functional/aesthetic wax-up in centric relation
  27. 27. wax-up used for a preparation guide
  28. 28. “minimal invasive”
  29. 29. provisional restorations (chair side made)
  30. 30. test aesthetics, function, phonetics with the provisional restorations (chair side made)
  31. 31. Light Transmission
  32. 32. Adhesive Techniques
  33. 33. Try-in ceramics
  34. 34. Final Result
  35. 35. Final Result
  36. 36. 20 Month Result
  37. 37. radiographic follow up
  38. 38. 5 Year Result

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