Patient 4

Patient 4

* female

* 55 years

* medical condition: none

* patient’s request

- improvement of the aesthetics of her upper teeth

Facial Analysis

Digital Facebow

Facial Analysis

long upper lip

Facial Analysis

excessive soft tissue display

wnl/gummy smile (posterior)

facial/dental midline

WNL (slight to the left)

Facial /dental Analysis

facial/dental midline

WNL (slight to the left)

Facial Analysis

Straight profile

Facial Analysis Lips in Repose

+/- 4 mm tooth structure

Facial Analysis Full Smile

Lip Dynamics High lip dynamics

Dental Analysis15 mm frialit implant

Seibert class IIISeibert class I

11.5 mm

overbite: 5 mm CRO = MIP

Dental Analysis Loss of anatomical form

wear anterior teeth (deep bite)

wear posterior teeth/flat restorations

Dental Analysis Loss of anatomical form (dento-alveolar eruption)

wear anterior teeth (deep bite)deep curve of spee

Dental Analysis dento-alveolar compensation ( premolars)

slight angle classs IIoverbite: 5 mm

angle classs II

overjet: 4 mm

Intra-Oral Examination

X-ray Examination

patient visits a oral hygienist 2-3 times a year

and oral hygiene is at a good level, no abnormal

probing depths

deep bite due to dento alveolar eruption of lower anterior teeth due to restorations of the anterior teeth

diagnosis

crowding lower anterior teeth and malposition 23 and 24 (25 not present)

mal-positioned implant 22

soft tissue deficiency siebert class III 22 and siebert class I 12

dento-alveaolar eruption premolars upper jaw

los of anatomical form due to restorations: 16,15,14,26,27 34-37 and 44-47

wear lower anterior teeth (attrittion)

what are the patient’s financial constraints?

how could we satisfy the patient’s aesthetic?

how to treat the hard and soft tissue deficiencies in the aesthetic zone

Is the patient willing to go through orthodontic and surgical procedures surgery

can we restore this patient predictably with long-term strategy?

primary concerns

what to do with the implant at the 22

improve hard and soft tissue volume at the 12 and 22

restore anatomy of the teeth

satisfy aesthetic concerns

develop long term-strategy

treatment objectives

create a stable occlusion with anterior guidance

treatment plan

wax-up

hard and soft tissue graft 22

provisional restoration 21=22=23

connective tissue graft pontic site 22

copy provisionals to ceramic restoration

soft tissue healing and maturation

contouring soft tissue through provisional restoration prep teeth for restorations (16-27 and 33-37,43-47)

and open vdo in provisional restoration phase and recontour lower anterior

(patients doesn’t want ortho)

evaluate biology, function and aesthetics 3 months

Treatment options Increasing the VDO

lower anterior rotate back, more ClassII

Treatment optionsChange Angle of

Restorations

With or without surgical crown lengthening

Initial Wax-Up

Initial Wax-Up

provisional bridge

surgical

procedure

3 months healing

aesthetic/functional wax-up

vacuum shell (duran)

prep guide for sufficient reduction

if necessary adjust preparation

measure provisional restoration thickness

Communication to laboratory

VDO registration impression

6

try inn zirconia frame work

pick-up soft tissue details

2 Year Result