Smile makeover by gingival contouring and direct composite veneers

A clinical case by our Community member Dr. Maxstein Abuzaid

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.

One of the most crucial criteria in modern dentistry is the reestablishment of a patient’s dental aesthetics. Recent advancements in the field of adhesive dentistry have broadened and changed restorative dental practice. In fact, dental composite veneers have developed into a solution for anterior teeth in the modern dental industry with a tendency towards minimal intervention. Direct placement of composite veneers provide greater material control, require only a small amount of tooth structure to be removed, and is easily repairable and modifiable at any point. Further, the use of a Digital Smile Design (DSD) and a mock-up technique for Aesthetic Crown Lengthening (ACL) was a predictable treatment to correct smile disharmony in the patient’s mouth. The following clinical case depicts the use of this aesthetic restorative material by means of a DSD approach.

style italiano styleitaliano First appointment

Fig.1
Pre-operative photographs were taken to analyze the smile of the patient.
A female patient came to the dental office demanding a better smile. She refused orthodontic treatment and preferred a more rapid line of treatment. After evaluation of her smile clinically and radiographically, and based on the DSD, ACL was performed.
Diastema closure and direct composite veneer were the golden option here. Not only are direct composite veneers a minimally invasive approach, but also accept future correction and reintervention. With today’s resin composite materials and accurate polishing techniques, the durability of direct restorations increased in addition to the fact that they were one of the most conservative options.

style italiano styleitaliano Pre-operative photographs

Fig.2
Pre-operative photographs showing gingival tissues covering parts of the teeth, also known as “Gummy Smile”. Diastema appears between upper anterior teeth, and a tilted left central incisor is observed as well.

style italiano styleitaliano Smile design dsd digital smile design

Fig.3
A DSD was done to better frame the field of work.

style italiano styleitaliano dsd digital smile design

Fig.4
The work was initiated with a DSD to design the new smile of the patient and to serve as a guide for the ACL perio-surgery.

style italiano styleitaliano Crown lengthening

Fig.5
ACL surgery is indicated in this case to provide adequate clinical crown length, ensuring gingival symmetry and harmony. This picture was taken prior to the surgery.

style italiano styleitaliano mock-up

Fig.6
After inserting the mock-up into the patient‘s mouth, bleeding points were detected.

style italiano styleitaliano Crown lengthening steps

Fig.7
Step by step guide of the surgery: Removal of some bony exostosis was done, then stitches were placed. A follow-up was mandatory to check the healing progress and to remove the suture.

style italiano styleitaliano isolation

Fig.8
Isolation was done to prepare the teeth for the restorative work.

style italiano styleitaliano composite build-up

Fig.9
In this case, choosing Medium Dentin (MD) and Light Enamel (LE) shades from GC Essentia offered her a color matching natural white teeth.

style italiano styleitaliano proximal and palatal walls creation

Fig.10
A rubber index for building the palatal enamel shell was used. Matrix bands from Palodent V3 sectional matrix system were placed for proximal walls and emergence profile creation.

style italiano styleitaliano Finishing and polishing

Fig.11
Finishing and polishing using Enhance finishing system and Enhance POGO cups with Prisma Gloss polishing paste, gave the composite veneers a highly polished shiny appearance.

style italiano styleitaliano Complete intraoral view of the initial and the final situation

Fig.12
Complete intraoral view of the initial and the final situation.

style italiano styleitaliano final situation

Fig.13
Final outcome. The patient was satisfied.

style italiano styleitaliano final outcome

Fig.14
The patient was happy and satisfied with the result.

Conclusions

Nature is the ideal model to imitate, and the comprehension of what nature looks or feels like is essential in aesthetic dentistry.
Nowadays, clinicians are able to offer beautiful smiles conservatively without any loss of the tooth structure. It was a challenge to combine the functional, aesthetic, and biological considerations to satisfy the patient.

Bibliography

1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
2. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent. 2010 Mar 1;5(1):102-24.
3. Devoto W, Pansecchi D. Composite restorations in the anterior region: clinical and aesthetic performances. Practical Procedures & Aesthetic Dentistry: PPAD. 2007 Sep 1;19(8):465-70.
4. Ortensi L, Sigari G, La Rosa GR, Ferri A, Grande F, Pedullà E. Digital planning of composite customized veneers using Digital Smile Design: Evaluation of its accuracy and manufacturing. Clinical and Experimental Dental Research. 2022 Apr;8(2):537-43.
5. Narayan S, Narayan TV, Jacob PC. Correction of gummy smile: A report of two cases. Journal of Indian Society of Periodontology. 2011 Oct;15(4):421.
6. Two S, Temporaries AP. Discovering the artist inside: A three-step approach to predictable aesthetic smile designs, part 2. Dent Today. 2013 Jul;32(7):126-8.

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