J Korean Acad Prosthodont.  2018 Jan;56(1):40-49. 10.4047/jkap.2018.56.1.40.

Functional and esthetic improvement through systematic diagnosis and treatment procedures in patient with unaesthetic anterior teeth proportion because of tooth wear: A case report

• Jeong HY
• Choi YS

• KMID: 2402986
• DOI: http://doi.org/10.4047/jkap.2018.56.1.40

Abstract

It is reported that the causes of unaesthetic proportion of anterior teeth vary widely. Especially, when the unaesthetic tooth proportion of the mandibular incisors arises due to the wear of the anterior teeth accompanied by the compensation of the alveolar bone, it may cause serious functional and aesthetic problems. In such case, it should be considered that the evaluation of vertical dimension and tooth proportion as well as smile line, soft tissue and hard tissue morphology. And, increase of vertical dimension or clinical crown lengthening followed by prosthodontic restorations is needed to improve the interdental mesial/distal, width/length ratio considering the anterior guidance. This case report demonstrates functional and aesthetic improvements through systematic diagnosis and treatment procedures in a 48-year-old male patient with unaesthetic anterior teeth proportion because of tooth wear accompanied by the compensation of alveolar bone and defect of several central incisors due to chronic periodontitis.

Keyword

Aesthetics; Vertical dimension; Crown lengthening; Anterior guidance; Diagnostic wax-up; Smile line

MeSH Terms

Chronic Periodontitis
Compensation and Redress
Crown Lengthening
Diagnosis*
Esthetics
Humans
Incisor
Male
Middle Aged
Tooth Wear*
Tooth*
Vertical Dimension

Figure

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  Fig. 1 Initial extra-oral photographs in frontal and lateral view. (A) Facial midline with the midline of central incisors, (B) Rickett's E-plane, (C) Naso-labial angle.

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  Fig. 2 Frontal view of initial photograph. (A) Intra-oral photograph, (B) Slight smile view, (C) Maximum smile view.

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  Fig. 3 Analysis of teeth width and length. (A) Maxillary anterior teeth, (B) Mandibular anterior teeth.

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  Fig. 4 Analysis of cephalometric projection. (A) Lateral cephalometric radiograph, (B) Tracing of lateral cephalometric radiograph.

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  Fig. 5 Analysis of Inter-occlusal distance. (A) Rest vertical dimension, (B) Occlusal vertical dimension.

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  Fig. 6 Analysis of Periodontal tissue and crown/root ratio for clinical crown lengthening. (A) Bone sounding, (B) Analysis of anatomic crown/root ratio.

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  Fig. 7 Semi-articulator mounting procedures. (A) Face-bow transfer, (B) Mounting the diagnostic model to an articulator in lateral view, (C) Mounting the diagnostic model to an articulator in frontal view.

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  Fig. 8 Fabrication of the custom anterior guide table. (A) Right excursion in frontal view, (B) Left excursion in frontal view, (C) Protrusive excursion in lateral view.

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  Fig. 9 Diagnostic wax-up in diagnostic model. (A) Wax-up on the mandibular anterior teeth, (B) Duplication of mandibular wax-up model, (C) Wax-up on the palatal surface of the maxillary anterior teeth, (D) Facial bite recording, (E) Re-mounting according to facial bite, (F) Wax-up on the labial surface of the maxillary anterior teeth.

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  Fig. 10 Fabrication of the surgical template and the provisional restoration. (A) Full contour wax-up, (B) Surgical template, (C) Provisional restoration.

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  Fig. 11 Surgical template application and clinical crown lengthening procedure. (A) Application of surgical template on the maxillary anterior teeth, (B) Application of surgical template on the mandibular anterior teeth.

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  Fig. 12 Teeth preparation and provisional restoration application. (A) Frontal view after teeth preparation, (B) Occlusal view after teeth preparation, (C) Frontal view after provisional restoration delivery.

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  Fig. 13 Individual tray fabrication and final impression taking. (A) Cord packing of maxillary anterior teeth, (B) Cord packing of mandibular anterior teeth, (C) Final impression of maxillary teeth, (D) Final impression of mandibular teeth.

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  Fig. 14 Cross mounting of the master model with diagnostic model. (A) Mounting of the diagnostic models, (B) Mounting of the diagnostic model and master model, (C) Mounting of the master models.

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  Fig. 15 Final setting by Rely X U200 (Shade A2, 3M ESPE, USA). (A) Frontal view of maxillary anterior teeth, (B) Frontal view of mandibular anterior teeth.

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  Fig. 16 Comparison of before and after treatment. (A) Frontal view before treatment, (B) Smile line before treatment, (C) Lateral view before treatment, (D) Frontal view after treatment, (E) Smile line after treatment, (F) Lateral view after treatment.

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