There is an art to smile design. Â Simply hoping to satisfy the needs of the patient isn’t always enough – patients aren’t trained to recognize what is possible. Â The following case is an example of utilizing smile design principles and photography to achieve results.
** Â I recognize that ideally this case could (and should) be done with ortho vs restorative treatment. Â But we must choose our battles. Â I sleep well at night knowing that I offered all the options to the patient. **
Mr. Jones came to our office unhappy with his smile.
We discussed several options – whitening, orthodontics, bonding, veneers, and/or combination of several of these. Â He wasn’t sure what exactly would achieve his goals. Â After discussing some more and listening closely we determined that he was unhappy with shape and spacing of his front four teeth. Â We chose to focus our treatment on the anterior four (#7 to #10).
After doing a digital smile analysis I discovered that tooth #9 was going to be problematic to achieve a great result. Â The tooth was distalized and needed to be moved mesially. Â Ideally this is accomplished via orthodontics, but can also be achieved restoratively through aggressive preparation. Â In this case the patient opted for restorative.
With all our smile cases our first step is to whiten the teeth. Â We do this to improve the smile so the restorative isn’t so obvious. Â This is especially important when doing less than 10 teeth. Â I try to avoid a big difference between porcelain and natural tooth.
After whitening the next step is restorative. Â My first step is to ‘scribe’ the margin prior to any tissue modification. Â This way I know where the natural margin line is and not confused when (if) we place cord or laser the tissue. Â I want to avoid leaving my supragingival when it needs to be subgingival and subgingival when I want it supragingival.
When closing a diastema it is important to carry your margin subgingival to allow room for the restoration to emerge and avoid the dreaded black triangle. Â It is also creates a more natural hygienic form for the patient.
In this case we now need to ‘slenderize’ tooth #9. Â This is done based on the golden proportions from our digital smile design. Â The tooth is slenderized and then a fine bur is used to slenderize the root as well. Â After this room for the porcelain is created.
Final impressions are taken, ‘test drive’ provisionals are made, and case is sent to the lab. Â I make effort to stay in contact with the laboratory throughout the case and make use of digital communication to achieve excellent results. Â Personally, I prefer to approve each step of the case – waxup, contouring, and final glaze prior to case being back to the office. Â This allows me to catch any issues and also communicate with patients how the case is coming along.
The case is returned to the office and bonded in place. Â The result is a beautiful, harmonious smile.