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Patient 1
* female
* medical condition: none
* patient’s request
- get rid of her pain in the her
upper anterior teeth and she
wants to get her “old” smile
back (referred patient)
* 30 years
Patient 1
history:
crown lengthening after 6
porcelain restoration have been
placed.
Digital Facebow
November 2010
Facial Analysis
Facial Analysis
Facial Analysis
Facial Analysis Lips in Repose
+/- 4 mm tooth structure
Facial Analysis Full Smile
Lip Dynamics WNL
Dental Analysis
21 rootcanal (due to pain)
13 mm
8.3 mm
x-ray’s
initial periodontal chart
Diagnosis
* iatrogenic damage to soft tissue and teeth (13-23):
violation of biologic width resulting in crown
lengthening
* leakage ceramic restorations
(bacteria) causing soft tissue
inflammation
* gummy smile
* long anterior teeth upper jaw
* To much tooth exposure with lips in repose /
dynamic interference anterior teeth with lower
lip during smiling
* buccal corridor in conflict with anterior region
primary concerns
* how to eliminate the pain in her teeth
* How to “heal” the affected soft tissue
* How to re-establish correct tooth proportions
* How to restore her teeth long term
* How to meet her aesthetic wishes (want “old smile” back)
treatment objectives
* re-create healthy soft tissue around the restorations
* improve length-width ratio’s of her upper anterior teeth
* improve the aesthetics of her smile
* eliminate pain
* improve soft tissue positions (facially) of tooth 13-23
treatment plan
* remove old ceramic restorations
* cement provisionals (13-23) with the correct l/w ratio
* re-create a new CEJ position restoratively
* soft tissue healing phase
* root coverage with Allograft (alloderm) using the tunnel
technique
* healing and maturation phase soft tissue (6 months)
* ceramic restorations 13-23
November 2010
March 2012
1.5 years after placement provisionals
Re- established tooth contour (CEJ-form)
March 2012
Re- established tooth contour Cemento-restorative margin
Miller Class I
periodontal re-evaluation
x-ray re-evaluation
Oktober 2013
Soft Tissue levels alterations Tunnel Technique with Alloderm
S
h
a
d
e
Smile Evaluation
re-evaluate provisionals
(3 years in function)
Try inn Ceramic Restorations
Patient1
4 years after start treatment
Patient1
Patient1
X-Photo examination

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Patient1