Small Changes for a Big Difference

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

 

This case involved a pleasant young woman who wanted to improve her smile. In her history she noted a traumatic injury where #9 was partially avulsed and subsequently had ankylosed (Figures 01, 02). She also wanted her teeth to be a more uniform color and lighter (Figure 03). Teeth #7 and #10 had prominent horizontal fractures that were likely from the same accident and had been and still were vital and asymptomatic (Figure 04). Tooth #8 was also facially placed in the arch (Figure 05).

    

We gathered records to treatment plan the case and decided a direct mock-up of the desired result would be appropriate. A diagnostic wax-up was done and then transferred to the mouth using B1 Luxatemp. The patient’s father, a retired dentist, was present to see the mock-up (Figure 06). Having a friend or family member present at the mock-up reveal is often helpful to support a decision made by the patient.

The treatment plan included periodontal evaluation and oral prophylaxis, whitening, osseous crown lengthening #9, mesio-incisal composites #6 and #11, ceramic veneers #7-#10 and a post-treatment maxillary full occlusal night guard.

Cord was packed in the facial gingival sulcus on tooth #9 and a direct composite veneer was placed before surgical crown lengthening (Figure 07). The gingival contour was left over contoured until after the flap was made for the surgical access (Figure 08). The intra-sulcular flap was incised with an ophthalmic micro crescent blade and the attached tissue blunt dissected and stretched to allow slow speed round bur access for osseous reduction. The gingival aspect of the composite veneer was then recontoured to place the facial height of contour more apical than the original tooth shape. This would allow for more symmetric healing of the gingival form compared with #8. The site was stabilized with one 6-0 Ethicon Prolene horizontal mattress suture (Figures 09 and 10).

   

After eight weeks of healing, teeth #7-#10 were prepared for ceramic (Ivoclar eMax) veneers. To keep the preparations as conservative as possible, a stent with Luxatemp (Figure 11) was placed over the teeth and depth cuts were made through the material with a 0.5mm wheel diamond (Figure 12). The Luxatemp material was then removed leaving depth marks where reduction was necessary, but other areas required none (Figure 13). This technique allows for maximum conservation of enamel that is good for strength, bonding and reduces possible sensitivity. Excellent aesthetic provisionals were made to most importantly test the function and psychological acceptance of the patient (Figures 14 and 15).

    

Often, the final restorations are custom characterized (Figure 16) at the delivery appointment. The final results have symmetry in shape, texture and color (Figures 17 and 18), and blend into the envelope of function. Excellent marginal integrity, contours that are biologically compatible, along with good oral hygiene are the reasons for the excellent gingival health (Figure 19).

   

Even though these are small individual changes, the sum total is apparent in the final photograph—a pleasing smile and a happy patient (Figure 20).

 

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 International 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. Dr. Spoor also is currently offering hands-on live patient treatment programs in aesthetics through The Center for Exceptional Practices (www.exceptionalpractices.com). He may be contacted at spoordds@msn.com.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: