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MY BEST INDIRECT CASE          Vol II 2008



   Treatment of Excessive Gingival Display and Anterior Overeruption:
   Rehabilitation and Restoration


   In order to develop a normal
   physiologic relationship
   between the osseous crest
   and correct the incisal
   positioning of the gingival
                                      1.                                    2.
   margin as related to the CEJ,
   surgical correction of the
   patient’s excessive gingival
   display was required.

   Once sufficient crown
   length was present,
   the anterior dentition
   were prepared for
   porcelain restoration and
                                      3.                                    4.
   provisionalized.
   Aesthetic rehabilitation was
   performed using a feldspathic   1. The patient presented with          2. Discoloration and alignment
   veneer system that would           excessive gingival display due to      were also areas of concern noted
   provide natural fluoresence        active altered eruption.               during treatment planning.
   and light transmission, while
   neutralizing the underlying     3. Occlusal view of the maxillary      4. The diagnostic model was used
   tooth shades.                      region demonstrates compro-            to determine the desired bone
                                      mised rotation and preexisting         levels following periodontal
                                      restorations.                          rehabilitation.




Jay M. Lerner, DDS*
Peter Kouvaris, CDT†
*Private practice, Palm Beach
 Gardens, Florida.
† Laboratory technician and VP/
  Partner, JK Dental Laboratory,
  Port Washington, New York.
5602 PGA Boulevard, Suite 201
West Palm Beach, FL 33418
Tel.: 561-379-8787
E-mail: lernerlemongello@aol.com

                                                            5. Following final soft tissue healing, the teeth were
                                                               prepared for all-ceramic restorations.
                                                                                                                     7
Jay M. Lerner, DDS, Peter Kouvaris, CDT




         6.   Provisional restorations were
              placed with the incisal edges
              brought to proper length.




         7.   A silicone template was fabri-
              cated based on the diagnostic
              waxup of the provisionalized
              teeth to ensure development of
              optimal tooth contours.




        8. The required porcelain thickness was veri-      9. The initial porcelain layering was conducted
           fied on the model prior to initial layering.       using a feldspathic ceramic (JK Veneer, JK
                                                              Dental Laboratory, Port Washington, NY).




       10. Additional porcelain characterization was       11. Interproximal cutback and facial character-
           added to the cervical third to ensure a natu-       ization were required to provide optimal
           ral transition to the gingival tissue.              light transmission.




8
MY BEST INDIRECT CASE          Vol II 2008




12. Appearance of the definitive restorations following firing.
    Note the aesthetic light transmission and refraction.




                                                                          13. Occlusal appearance of the
                                                                              definitive restorations.




                14. Note the improved crown visibility and elimination
                    of excessive gingival display during natural smile.




                15. Postoperative appearance of the definitive restorations
                    demonstrates aesthetic harmony and a natural emer-
                    gence profile.




                                                                                                           9

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Tratamiento de encía excesiva y sobreerupción anterior.

  • 1. MY BEST INDIRECT CASE Vol II 2008 Treatment of Excessive Gingival Display and Anterior Overeruption: Rehabilitation and Restoration In order to develop a normal physiologic relationship between the osseous crest and correct the incisal positioning of the gingival 1. 2. margin as related to the CEJ, surgical correction of the patient’s excessive gingival display was required. Once sufficient crown length was present, the anterior dentition were prepared for porcelain restoration and 3. 4. provisionalized. Aesthetic rehabilitation was performed using a feldspathic 1. The patient presented with 2. Discoloration and alignment veneer system that would excessive gingival display due to were also areas of concern noted provide natural fluoresence active altered eruption. during treatment planning. and light transmission, while neutralizing the underlying 3. Occlusal view of the maxillary 4. The diagnostic model was used tooth shades. region demonstrates compro- to determine the desired bone mised rotation and preexisting levels following periodontal restorations. rehabilitation. Jay M. Lerner, DDS* Peter Kouvaris, CDT† *Private practice, Palm Beach Gardens, Florida. † Laboratory technician and VP/ Partner, JK Dental Laboratory, Port Washington, New York. 5602 PGA Boulevard, Suite 201 West Palm Beach, FL 33418 Tel.: 561-379-8787 E-mail: lernerlemongello@aol.com 5. Following final soft tissue healing, the teeth were prepared for all-ceramic restorations. 7
  • 2. Jay M. Lerner, DDS, Peter Kouvaris, CDT 6. Provisional restorations were placed with the incisal edges brought to proper length. 7. A silicone template was fabri- cated based on the diagnostic waxup of the provisionalized teeth to ensure development of optimal tooth contours. 8. The required porcelain thickness was veri- 9. The initial porcelain layering was conducted fied on the model prior to initial layering. using a feldspathic ceramic (JK Veneer, JK Dental Laboratory, Port Washington, NY). 10. Additional porcelain characterization was 11. Interproximal cutback and facial character- added to the cervical third to ensure a natu- ization were required to provide optimal ral transition to the gingival tissue. light transmission. 8
  • 3. MY BEST INDIRECT CASE Vol II 2008 12. Appearance of the definitive restorations following firing. Note the aesthetic light transmission and refraction. 13. Occlusal appearance of the definitive restorations. 14. Note the improved crown visibility and elimination of excessive gingival display during natural smile. 15. Postoperative appearance of the definitive restorations demonstrates aesthetic harmony and a natural emer- gence profile. 9