J Korean Acad Prosthodont.  2015 Jul;53(3):262-275. 10.4047/jkap.2015.53.3.262.

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

• Lee SM
• Choi YS

• KMID: 2195259
• DOI: http://doi.org/10.4047/jkap.2015.53.3.262

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.

Keyword

Esthetics; Dento-facial composition; Peg lateralis; Diagnostic wax-up; Smile line; Porcelain laminate veneer

MeSH Terms

Dental Porcelain
Diagnosis*
Diastema
Esthetics
Female
Gingivectomy
Humans
Prosthodontics
Reproduction
Tooth*
Dental Porcelain

Figure

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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.

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  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®.

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  Fig. 3. Initial intraoral photographs in centric occlusion. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 4. Initial intraoral photographs. (A) Right lateral view, (B) Maxillary anterior view, (C) Left lateral view.

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  Fig. 5. Analysis of smile line at initial visit. (A) Rest state view, (B) Slight smile view, (C) Maximum smile view.

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  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".

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  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.

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  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%).

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  Fig. 9. Gingivectomy using template. (A) Template (Duran®, SCHEU-DENTAL GmbH, Iserlohn, Germany) fabrication, (B) Template application, (C) After gingivectomy.

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  Fig. 10. Follow-up after one month. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 11. Silicone index fabrication. (A) Frontal view, (B) Occlusal view, (C) Incisal view.

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  Fig. 12. Mock-up fabrication and abutment preparation. (A) Spot etching, (B) Mock-up fabircation, (C) Abutment preparation, (D) Removal of resin excess.

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  Fig. 13. Final impression taking. (A) Cord packing, (B) Final impression, (C) Master cast fabrication.

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  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.

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  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.

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  Fig. 16. Comparison of before and after treatment. (A) Frontal view, (B) Right lateral view, (C) Maxillary anterior view, (D) Left lateral view.

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  Fig. 17. Smile line improvement. (A) Dentofacial view, (B) Frontal view, (C) Semi-lateral view, (D) Lateral view.

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  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.

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  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®.

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  Fig. 20. Initial intraoral photographs in centric occlusion. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 21. Initial intraoral photographs. (A) Right lateral view, (B) Maxillary anterior view, (C) Left lateral view.

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  Fig. 22. Analysis of smile line at initial visit. (A) Rest state view, (B) Slight smile view, (C) Maximum smile view.

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  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%).

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  Fig. 24. Gingivectomy using template. (A) Template (Duran®, SCHEU-DENTAL GmbH, Iserlohn, Germany) fabrication, (B) Template application, (C) After gingivectomy.

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  Fig. 25. Follow-up after one month. (A) Right lateral view, (B) Frontal view, (C) Left lateral view.

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  Fig. 26. Mock-up fabrication and abutment preparation. (A) Spot etching, (B) Mock-up fabircation, (C) Abutment preparation, (D) Removal of resin excess.

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  Fig. 27. Final impression taking. (A) Cord packing, (B) Final impression, (C) Master cast fabrication.

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  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.

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  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.

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  Fig. 30. Comparison of before and after treatment. (A) Frontal view, (B) Right lateral view, (C) Maxillary anterior view, (D) Left lateral view.

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  Fig. 31. Smile line improvement. (A) Right lateral view, (B) Left lateral view.

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