Journal List > J Korean Acad Prosthodont > v.53(3) > 1034836

Lee and Choi: Esthetic improvements through systematic diagnosis and treatment procedures in patients with unesthetic maxillary anterior teeth proportion after orthodontic treatment: Case report

Abstract

The treatment of areas demanding esthetic requirements, such as maxillary anterior teeth, should take into account the achievement of a healthy, harmonious to the surrounding tissue, and an attractive smile line. In this case report, smile line, soft tissue and hard tissue morphology, and the anatomy and proportion of the tooth, must be considered. In patients with unesthetic maxillary anterior ratio due to inadequate gingival contour and diastema caused by peg lateralis, it would be challenging to achieve an esthetic restoration by orthodontic treatment alone. In such case, after orthodontic treatment, dento-gingivo-facial compositional diagnosis and analysis, followed by gingivectomy and prosthodontic restoration is needed to improve the interdental mesial/distal, width/length ratio to achieve a satisfactory esthetic result. In addition, when improving the tooth proportion of peg lateralis by prosthodontic treatment, Porcelain laminate veneer (PLV), which results in less tooth structure loss, reproduction of similar shade to that of the proximal tooth and high transparency, is recommended. This case report demonstrates esthetic improvements by prosthodontic restoration through systematic diagnosis and treatment procedure in patients with unesthetic maxillary anterior proportion after orthodontic treatment due to peg lateralis by means of two female patients aged twenty years old.

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Fig. 1.
Initial extraoral photographs in frontal view. (A) Facial midline with the midline of central incisors, (B) Horizontal parameters relating the inter-pupillary line to the incisal edge position, (C) Full-facial analysis.
jkap-53-262f1.tif
Fig. 2.
Initial extraoral photographs in lateral view. (A) Rickett' s E-plane indicating the distance to the upper lip less than 4 mm, (B) Nasio-labial angle less than 90®.
jkap-53-262f2.tif
Fig. 3.
Initial intraoral photographs in centric occlusion. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.
jkap-53-262f3.tif
Fig. 4.
Initial intraoral photographs. (A) Right lateral view, (B) Maxillary anterior view, (C) Left lateral view.
jkap-53-262f4.tif
Fig. 5.
Analysis of smile line at initial visit. (A) Rest state view, (B) Slight smile view, (C) Maximum smile view.
jkap-53-262f5.tif
Fig. 6.
Analysis of anterior smile line.7 (A) Calculating the length of the teeth using the width/length ratio of 78%, (B) Designing the gingival esthetic line based upon the esthetic parameters, (C) Determining of the position of the central incisors using facial midline, (D) Creating midline symmetry, (E, F) Determinig of the size of the lateral incisors and canines using principles of tooth proportions, the "golden proportion".
jkap-53-262f6.tif
Fig. 7.
Semi-articulator mounting procedures. (A) Facebow transfer (B) Mounting the diagnostic model to an articulator in frontal view (C) Mounting the diagnostic model to an articulator in lateral view (D) Diagnostic model.
jkap-53-262f7.tif
Fig. 8.
Model Analysis. (A) Analysis of diagnostic model (B) Diagnostic waxup in diagnostic model (Application of ideal teeth width/length ratio 78% and golden proportion 62%).
jkap-53-262f8.tif
Fig. 9.
Gingivectomy using template. (A) Template (Duran®, SCHEU-DENTAL GmbH, Iserlohn, Germany) fabrication, (B) Template application, (C) After gingivectomy.
jkap-53-262f9.tif
Fig. 10.
Follow-up after one month. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.
jkap-53-262f10.tif
Fig. 11.
Silicone index fabrication. (A) Frontal view, (B) Occlusal view, (C) Incisal view.
jkap-53-262f11.tif
Fig. 12.
Mock-up fabrication and abutment preparation. (A) Spot etching, (B) Mock-up fabircation, (C) Abutment preparation, (D) Removal of resin excess.
jkap-53-262f12.tif
Fig. 13.
Final impression taking. (A) Cord packing, (B) Final impression, (C) Master cast fabrication.
jkap-53-262f13.tif
Fig. 14.
Laminate fabrication. (A) Final Wax-up, (B) IPS e.max® Press HT ingot (Shade A1, Ivoclar vivadent, Schaan, Leichtenstein), (C) Laminate try-in at master cast.
jkap-53-262f14.tif
Fig. 15.
Final setting by Variolink® N (Yellow shade, Ivoclar vivadent, Schaan, Leichtenstein). (A) Right lateral view, (B) Semi-right lateral view, (C) Frontal view, (D) Semi-left lateral view, (E) Left lateral view.
jkap-53-262f15.tif
Fig. 16.
Comparison of before and after treatment. (A) Frontal view, (B) Right lateral view, (C) Maxillary anterior view, (D) Left lateral view.
jkap-53-262f16.tif
Fig. 17.
Smile line improvement. (A) Dentofacial view, (B) Frontal view, (C) Semi-lateral view, (D) Lateral view.
jkap-53-262f17.tif
Fig. 18.
Initial extraoral photographs in frontal view. (A) Facial midline with the midline of central incisors, (B) Horizontal parameters relating the inter-pupillary line to the incisal edge position, (C) Full-facial analysis.
jkap-53-262f18.tif
Fig. 19.
Initial extraoral photographs in lateral view. (A) Rickett' s E-plane indicating the distance to the upper lip less than 4 mm, (B) Nasio-labial angle less than 90®.
jkap-53-262f19.tif
Fig. 20.
Initial intraoral photographs in centric occlusion. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.
jkap-53-262f20.tif
Fig. 21.
Initial intraoral photographs. (A) Right lateral view, (B) Maxillary anterior view, (C) Left lateral view.
jkap-53-262f21.tif
Fig. 22.
Analysis of smile line at initial visit. (A) Rest state view, (B) Slight smile view, (C) Maximum smile view.
jkap-53-262f22.tif
Fig. 23.
Model Analysis. (A) Analysis of diagnostic model, (B) Diagnostic waxup in diagnostic model (Application of ideal teeth width/length ratio 78% and golden proportion 62%).
jkap-53-262f23.tif
Fig. 24.
Gingivectomy using template. (A) Template (Duran®, SCHEU-DENTAL GmbH, Iserlohn, Germany) fabrication, (B) Template application, (C) After gingivectomy.
jkap-53-262f24.tif
Fig. 25.
Follow-up after one month. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.
jkap-53-262f25.tif
Fig. 26.
Mock-up fabrication and abutment preparation. (A) Spot etching, (B) Mock-up fabircation, (C) Abutment preparation, (D) Removal of resin excess.
jkap-53-262f26.tif
Fig. 27.
Final impression taking. (A) Cord packing, (B) Final impression, (C) Master cast fabrication.
jkap-53-262f27.tif
Fig. 28.
Laminate fabrication. (A) Final Wax-up, (B) IPS e.max® Press HT ingot (Shade A2, Ivoclar vivadent, Schaan, Leichtenstein), (C) Laminate try-in at master cast.
jkap-53-262f28.tif
Fig. 29.
Final setting by Variolink® N (Transparent shade, Ivoclar vivadent, Schaan, Leichtenstein). (A) Right lateral view, (B) Semi-right lateral view, (C) Frontal view,(D) Semi-left lateral view, (E) Left lateral view.
jkap-53-262f29.tif
Fig. 30.
Comparison of before and after treatment. (A) Frontal view, (B) Right lateral view, (C) Maxillary anterior view, (D) Left lateral view.
jkap-53-262f30.tif
Fig. 31.
Smile line improvement. (A) Right lateral view, (B) Left lateral view.
jkap-53-262f31.tif
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