gummy smile

Patients with a high aesthetic demand. A case report.

A clinical cases by our Community member Dr Lisa Fernandes Gonçalves .

 

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

 

The impact of the growing habit of self-education in medical care and wellness, and selfperception being greatly driven by social media can be both beneficial and harmful: on the one hand, having well informed patients facilitates their participation and understanding; however, on the other hand, a substantial amount of misinformation is also present online, which may make the consultation more difficult. Of course, the face-to-face consultation is still—and should always remain—central in creating trust and providing objective information about a procedure.
Although nowadays patients know exactly what they want, dentists are encouraged to ensure that people’s expectations of the treatment are both rational and realistic.
Body dysmorphic disorder (BDD) is an often under-recognised yet severe psychiatric illness, which is prevalent in people seeking non-surgical procedures usually with high expectations which may lead to post-operative depression and anxiety. Performing an aesthetic treatment in
such cases may complicate the procedure for the dentist and, more importantly, does not improve the quality of life for the patient. Because of that it’s important to identify patients with
BDD and patients with unrealistically high expectations before interventions.

A correct planning of a case is a key factor in order to obtain an aesthetically pleasing rehabilitation. Tools such as Wax-Up and Mock-up are still a very important instruments in the planning process. It helps us understand and evaluate the position of each tooth according to the smile design, geometric principles and facial lines based on the natural head position. Use of tools such as digital wax up can reduce the margin of error, disharmonies, canting and incorrect tooth proportions. The digital wax up should be incorporated in facial pictures or scanned faces.
Also the interaction between patient, clinician, and dental technician is crucial in the process of planning a case.

mmy smile with thick periodontist

Fig.1

40 Years old woman wanted to improve the aesthetics of her anterior upper teeth. She mainly complained about having small teeth, gummy smile, and unappealing tooth proportions. Because of her high aesthetic demand, she refused orthodontic treatment and additive composite restorations.

digital smile design for dentist patient communication

Fig.2

All photos were shared with the dental lab, and a digital smile design was made to help improve
communication with the patient.

digital wax-up from different angulations

Fig.3

Digital wax-up. The gingival margins and tooth proportions were corrected.

mock-up options for smile makeove

Fig.4

Three different mock-ups were used to achieve patient approval.

crown lengthening surgery for front teeth

Fig.5

Crown lengthening guided by our mock-up.

teeth after healing of soft tissues

Fig.6

Follow-up 6 months after surgery.

water spray from turbine

Fig.7

Tooth preparation guided by the mock-up.

prepared teeth for veneer rehabilitation

Fig.8

After tooth preparation and polishing (14-24). The old composite restorations were removed in both central incisors due to marginal infiltration.

silicone guide for veneer thickness preparation

Fig.9

The key to a conservative veneer treatment is to use a silicone guide, which allows us to control how much tooth structure is removed.

eldspathic ceramic veneers on model

Fig.10

Feldspathic ceramic veneers by Oleg Blashkiv.

cementing veneers under rubber dam isolation

Fig.11

Veneer cementation with rubber dam.

smile after veneer cementation

Fig.12

Final outcome.

detail of ceramic veneer texture

Fig.13

Details of the cemented veneers.

Conclusions

It’s very important that patients understand exactly what the treatment they need is, what will happen during the treatment, how long the recovery time should be, which potential complications might arise from those procedures, and what type of results are to be expected both immediately and in the long term in order to have a successful treatment.
For that it’s important to remember:
1. Listening is the most important skill in patient consultation
2. Dentists need to be aware and recognize patients who have high expectations
3. Setting realistic aesthetic goals is paramount
4. Make time to plan the treatment before any intervention.

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