Creative Aesthetics: An Alternative Way to a Better Smile

By: Rhys Spoor, DDS, FAGD, FADIA
Accredited Member of the American Academy of Cosmetic Dentistry

This case highlighted an alternative approach to get an improved smile for a patient that was not able to find a plan that fit what he was willing to do.  He had a Class III malocclusion but had a more than acceptable function (Fig01 and Fig02) with good periodontal health and no pain.  What he wanted was a nicer looking smile (Fig03) but didn’t want to accept the risks and involvement of orthognathic surgical correction after he had looked into that option several times in his past.  Because his Class III was exaggerated enough to provide clearance, it was decided and agreed to build his new smile in the Class III position.

We started with bleaching, (Fig04 and Fig05) partly because giving a patient a brighter smile early on in the treatment process gives motivation to continue on through parts of the treatment that are more arduous.  Additionally, having a lighter background to place veneers over allowed for thinner and more translucent veneer material.

Five months of straight wire orthodontics followed with the goal being general alignment of the dentition, still in Class III but a smoother arch form (Fig06).  Because this was arch expansion orthodontics the next stage of placing selected ceramic veneers would also act as retention.   The overall size of the veneered teeth were larger than the original teeth in the mesio-distal dimension which prevented post orthodontic relapse.

The maxillary anterior teeth and bicuspids were minimally prepped, partly because of the improved position from the limited orthodontics (Fig07 and Fig08).  The overall dimensions of the teeth were going to be increased in length and width.  Minimal preparation of the natural tooth structure left the teeth stronger, with no sensitivity and the best bondable surface (ie enamel).  The mandibular incisors and first molars were also minimally prepped at the same time (Fig09).

The restorative ceramic used was lithium disilicate (Ivoclar Vivadent eMax) for it’s strength , bondability and aesthetics (Fig10).  Vertical undulations were created in the surfaces of the incisors to help break up the light reflection and make a wider tooth look narrower (Fig11).

The final results show a nice improvement in aesthetics even in the Class III malocclusion (Fig12).  Increasing the size of the maxillary anterior teeth worked well to give a full and attractive smile (Fig13).  The boost to self esteem an improved smile is hard to describe but easy to see (Fig14) and was acheived in a way that firt into the parameters set by the patient.

Dr. Rhys Spoor is a 1983 graduate of the University of Washington where he was an Affiliate Assistant Professor in the Department of Restorative Dentistry for 10 years.  He is an Accredited Member of the American Academy of Cosmetic Dentistry, a Fellow of the Academy of General Dentistry, the American Dental Implant Association and the Pierre Fauchard Society.  He is also an Editorial Reviewer for the Journal of Cosmetic Dentistry. Dr. Spoor maintains a private practice in Seattle in aesthetic, implant and restorative dentistry. He may be contacted at spoordds@msn.com.

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