Patient 4 is a 42-year-old female with no medical conditions who requested improvement of the aesthetics of her upper anterior teeth, which were restored with composite to mask tetracycline discolorations. The treatment plan involved replacing the composite restorations with provisional and then ceramic restorations to improve the anatomical form, recontouring the lower anterior teeth and composites, and addressing excessive gingival display and crowding. The treatment was completed and the patient was happy with the results and planned to have her lower anterior teeth treated as well.

1. Patient 4

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. Facial Analysis
2-3 mm tooth structure visible with lips in repose

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. 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. Facial Analysis

7. Dental Examination

8. Dental Examination
1.0
0.8

9. Dental Examination (perio)

10. Dental Examination (x-ray)

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. 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. Dental Examination (old photo’s)

14. Dental Examination (planning)

15. Dental Examination (planning)
Over-contoured composite
restorations

16. Dental Examination (wax-up)

17. Dental Examination (planning/wax-up)
adjusted anatomy central
incisors

18. Dental Examination (planning)

19. Preparation guide (silicone)

20. Check preparation design (not enough reduction)

21. Check preparation designCheck preparation design (enough reduction)

22. Preparations

23. Shade communication with ceramist

24. Preparations (VPS impression)

25. Evaluation of the Provisionals

26. Ceramic Restorations

27. Rubberdam Isolation

28. Rubberdam Isolation

29. Final Result
before… …. after

30. Final Result

31. Final Result

32. Final Result

33. Dental Examination (x-ray)

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)