This document summarizes 6 smile design cases completed by Christian Coachman and other dentists. Each case summary includes 1-2 sentences on the pre-operative situation, treatment plan and materials used. Treatments included veneers, crowns, onlays and monolithic restorations using materials like Emax. The full case descriptions provide step-by-step explanations of the smile design process from facial analysis to mock-ups and final restorations.

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CHRISTIAN COACHMAN - FEB 14, 2019
6 Smile Design Cases
SMILE DESIGN CASE 1
GUREL/COACHMAN WORKFLOW FOR SMILE DESIGN PATIENTS (2009)
1 | MONOLITHIC BRIDGE
2 | CUTBACK + LAYERED CROWN
3 | CUTBACK + LAYERED VENEERS
4 | MONOLITHIC VENEERS
5 | MONOLITHIC ONLAY
Clinical work performed by Dr. Galip Gurel, Lab work perfomed by Christian Coachman and Adriano Schayder
SMILE DESIGN CASE 2
Smile Visagism Analysis (Braulio Prolucci Concept), The choice of this case was to create a mix design
between the Oval/Melancholic/Sensible with the Triangular/Sanguine/Dynamic.
EMAX HT PRESS was the material of choice, pressed with a thickness of 0.2-0.3mm
Ceramics by Christian Coachman
SMILE DESIGN CASE 3
Patient with worn dentition and gummy smile.
Always very interesting for the smile designer to ask for pictures of the patient smile when they were younger or
smile pictures from relatives that look alike the patient. It's what we call Morphological research, as I've learned
from CDT Juvenal de Souza.
Also always adding the dynamic facial analysis to the smile design process. A simple facial video that shows lip
dynamics and between teeth face in different angles and different moments.
2D smile frame with facial guide lines
Digitally testing some option, starting from ideal tooth proportion. First option was to achieve ideal proportion
by lengthening only incisally, avoiding crown lengthening but increasing functional interference and not for
the face/lip integration.
Second option was to move the teeth up completely, not changing the incisal edge position. Facilitating
function by creating a biological problem with an aggressive crown lengthening procedure and exposing
cementum.
Final decision was the in between common sense position. Little incisal edge that can be handled from the
functional stand point and less invasive crown lengthening keeping most of the prep in enamel.
Transferring the 2D smile design to the pre-op working model.
Quality control of the wax-up
Motivational mock-up
A "snap on" removable crown lengthening guide was made.
Guide in position
Surgery performed using the guide and respecting the biological width measurements.
After soft tissue healing.
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STEP 1 : Pre-op
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STEP 2 : Direct mock-up. For dentist with smile design and hand skills. The direct mock-up is a very good
strategy to motivate the patient.
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STEP 3 : Motivation. Presenting the direct mock-up to the patient.
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STEP 4 : Facial dynamic analysis
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STEP 5 : Initial interview. This appointment includes morpho-psychological interview for smile design
customization (visagism).
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STEP 6 : Facially driven 2D digital smile design project is performed based on the direct mock-up and
visagism interview.
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STEP 7 : Transferring the 2D Project to the model to guide the wax-up
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STEP 8 : Wax-up quality control
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STEP 9 : Based on the wry-up, indirect mock-up is performed and adjusted. Here, a black marker is used to
check the incisal length of the centrals before shortening it.
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STEP 10 : This technical direct mock-up is also known as apt and will be the prep and provisional guide.
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STEP 11 : Tooth preparatory by design. Tooth preparation is performed through the apt using depth cutters
to obtain the most minimally invasive prep with ideal clearance for material resistance and color change.
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STEP 12 : Final tooth prep and shade taking. Always taking photos with the stump shade and the desired
shade.
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STEP 13 : Provisional. An immediate provisional is made using the same silicone index made over the wax-
up.
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STEP 14 : Lithium dissilicate pressed restoration core. The cut back is controlled with the silicone guide.
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STEP 15 : Ceramic build-up. Also guided by the silicone index to keep the same approved shape of the
mock-up.
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STEP 16 : Final outcome
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STEP 17 : Follow up (3 years)
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2. Final tooth preparation and impression.
Perio-Prostho Clinical work by Eric Van Dooren, Ceramics by Christian Coachman
SMILE DESIGN CASE 4
Intraoral photo is calibrated to the facial photo with the guidelines.
2D Smile Design Project
After orthodontics, quality control procedure is done by overlapping the drawings to check if tooth movement
respected the initial project.
After removing the braces the 2D project is recalibrated.
The wax-up is done over the model after ortho.
Silicone guide done over the wax-up for the motivational mock-up.
The additive mock-up.
Presenting the mock-up to the patient initially with photos instead of the mirror is much more powerful from
the emotional aspect. After this appreciation, the patient can have the mirror to go over technical details and
modifications can be made with the black marker and discs.
This image shows the final prep without any reduction on the buccal neither on the incisal, just inter proximal
preps were needed to allow ideal tooth shapes on the ceramic veneers. This image also shows a very well
planned orthodontic movement to allow for almost prepless case to achieve the final ideal design.
Clinical procedures by Dr. Andrea Ricci
MONOLITHIC RESTORATION
This was my first anterior Monolithic case ever. Using Emax press LT A1 , stained and glazed. I was quite
impressed with the result.
Clinical procedures by Dr. Andrea Ricci, Lab work by Christian Coachman
SMILE DESIGN CASE 5
Pre-op situation. The issues were: color, diastemas, space distribution, incisal abrasion, recession/metal margin
and black triangles.
The goal was to close the gaps without orthodontics so a careful study was done on the model to plan the
shapes using optical illusion and finishing line of the preps to allow for proper emergence profile and avoid
disproportional teeth and black triangles.
The mock-up demonstrated that shapes were good and orthodontic could be avoided.
Pre-op
Tooth preparation. Breaking the contacts and going slightly sub gingival inter proximally to achieve better
emergence profile and ideal contacts without black triangles.
THE BLACK SPACE ANALYSIS
I always enjoyed taking photos of my own work, placing it on the slide and playing with contrasts and saturation
to create a complete black and white images. Analyzing these images is very powerful to help our eyes
evaluate the incisal embrasures and incisal edge silhouette. I usually do this before final glaze, allowing me
to fine tune the shapes. It is like looking at the teeth without looking at them and instead trying to visualize the
shapes of the background, THE NEGATIVE SPACE. When filling up extra space is important to work with the line
angles and push the challenge towards the most distal area. On this case line angles of centrals and laterals
were kept almost ideal and the extra space was mainly distributed by the canine. Also longer contacts were
designed to close the black triangles, but the line angles were kept more triangle to give a natural look.
Clinicial procedures by Dr. David Garber, Lab work by Christian Coachman
SMILE DESIGN CASE 6
Smile Designer Dentistry Esthetics Treatment Planning DSD Magazine
2D Digital Smile Design 2D Smile Design Project
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