J Dent Rehabil Appl Sci.  2019 Sep;35(3):170-179. 10.14368/jdras.2019.35.3.170.

Anterior esthetic restoration using DSD (digital smile design) for a patient with congenital missing tooth of maxillary central incisor

• Park HJ
• Lee JS

• KMID: 2463626
• DOI: http://doi.org/10.14368/jdras.2019.35.3.170

Abstract

The prosthodontic treatments in maxillary anterior teeth focus on achieving esthetic appearances. It is possible to improve the esthetic appearance by adjusting the shape, arrangement, and color of the maxillary anterior teeth. For anterior teeth restoration, it is necessary to evaluate the relationship of teeth, lip and gingival architecture with the facial profile of patient. Also, clinician needs to fully understand what the patient wants to. DSD (digital smile design) concept can be applied as a tool to improve communication with the clinician, technician and patient. In addition, DSD can help to meet the needs of the patient. In this case, it was impossible to achieve symmetry due to congenital missing of maxillary central incisor. The definitive treatment goal was to get the harmony of maxillary anterior teeth, lip and the patient's face. This case report describes that the patient and clinician got the satisfying esthetic outcome by using DSD.

Keyword

esthetics; anterior tooth restoration; digital smile design

MeSH Terms

Esthetics
Humans
Incisor*
Lip
Tooth*

Figure

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  Fig. 1 Initial radiographic image. (A) Panoramic view, (B) Periapical view. Crown fracture with pulpal exposure is shown.

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  Fig. 2 Pretreatment intraoral view showing missing of maxillary central incisor. (A) Occlusal view of maxilla, (B) Right lateral view, (C) Frontal view, (D) Left lateral view, (E) Occlusal view of mandible.

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  Fig. 3 Facial view of pretreatment aspect. Midline discrepancy and discoloration of maxillary central incisor are shown.

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  Fig. 4 DSD (digital smile design). (A) Analysis of shape of preoperative teeth, (B) Shape of designed teeth and smile arc(pretreatment; white bold line, modified; blue bold line). Comparison the aspect of teeth on patient’s face. (C) Pretreatment teeth, (D) Modified teeth.

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  Fig. 5 The diagnostic wax-up is fabricated using the DSD as a guide. (A) Pretreatment view, (B) DSD (digital smile design), (C) Diagnostic wax-up.

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  Fig. 6 Mock up.

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  Fig. 7 Provisional restoration. (A) Cemented as a long-term provisional, (B) Frontal view of provisional restoration.

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  Fig. 8 Tooth preparation and impression taking. (A) and (B) The putty index was used to guide and check the amount of reduction, (C) Final impression taking with VPS.

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  Fig. 9 IPS E.max coping try-in. (A) Positioning the coping on dental cast to verify marginal adaptation, alignment, (B) Coping try-in.

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  Fig. 10 Definitive prosthesis is fabricated. (A) Shade A1, (B) Shade A2.

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  Fig. 11 Analysis of intraoral view and extraoral view. (A) Before treatment, (B) After treatment. Esthetics of prosthesis is improved and the discoloration of central incisor is relieved. (C) Smile line before treatment, (D) Improved smile line after treatment.

Reference

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