This document summarizes the treatment plan for a 61-year-old male patient seeking improvement of the esthetics of his upper front teeth. The patient has a history of thrombosis and is on anticoagulant medication. An examination found excessive gum display when smiling, short upper front teeth, and wear from parafunction. The treatment plan involves creating provisional restorations to test aesthetics, function, and phonetics. Definitive ceramic restorations will then be made by copying the approved provisionals. A night guard will also be provided and follow-ups scheduled to ensure long-term success of the treatment.

1. Patient 6

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. Facial Analysis
Digital Facebow

4. Facial Analysis

5. Facial Analysis
excessive anterior
gingival display
anterior gummy
smile

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. Facial Analysis Lips in Repose
+/- 3 mm tooth structure

8. Facial Analysis Full Smile
Lip Dynamics WNL

9. Facial Analysis Full Smile
Anterior Gummy Smile

10. Dental Analysis
8 mm
9 mm
envelope of function??

11. Dental Analysis Wear

12. Dental Analysis

13. Dental Analysis Function
no tender muscles, no joint problems

14. FunctionDental Analysis

15. Dental Analysis Function
Central incisors
retroclined

16. intra-oral examination:
composite restoration metal ceramic crown

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. radiographic examination

19. radiographic examination

20. periodontal examination

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. 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. 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. 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. functional/aesthetic wax-up in centric relation

26. functional/aesthetic wax-up in centric relation

27. wax-up used for a preparation guide

28. “minimal invasive”

29. provisional restorations (chair side made)

30. test aesthetics, function, phonetics with the provisional
restorations (chair side made)

44. Light Transmission

45. Adhesive Techniques

46. Try-in ceramics

47. Final Result

48. Final Result

50. 20 Month Result

53. radiographic follow up

54. 5 Year Result