Mike Skramstad I wanted to post a fairly difficult central incisor case that I just completed...
This patient came to me wanting to improve her smile. She had some chipping and wear on tooth #8 and an old PFM on tooth #9 that had a previous RCT.
The tissue was extremely inflammed on #9 and the margin was quite subgingival. I determined that she had a biologic width invasion here that was likely going to need osseous crown lengthening....
So first, I planned the case out using simple photoshop smile design...
Here is where she needed her gingival crest to be on 8 and 9:
Here is where I planned where her teeth needed to be to have correct proportions. Tooth #8 needed to be lengthened slightly and the incisal edge on #9 was correct based on her lip at rest photo:
Then I quickly morphed the teeth into the correct position using photoshop:
So... the plan was the following:
- Prep and provisionalize the teeth to the correct position using a diode laser to recontour the tissue based on the original plan
- Send her to the Periodontist to perform osseous crown lengthening (mostly on #9) to get the tissue to respond and eliminate the Biologic Width problem
- Allow the tissue to heal
- Fabricate the final restorations
After removing the crown on #9... I got another suprise... ouch:
I opaqued the tooth to try the best I could to block it out and finalized the preparations on both 8 and 9:
I made the provisionals on 8 and 9 and sent her to the periodontist:
Two months later after healing, we did the final restorations out of e.max MT shade M1:
There was still a little darkness coming from the root of #9, but overall I was very pleased (and the patient was thrilled). If you look at the smile picture, it doesn't show :)
This was a long and difficult case to do... but I feel because it was planned properly and the patient understood what was needed, it turned out pretty good!
