J Dent Rehabil Appl Sci.  2024 Aug;40(3):179-188. 10.14368/jdras.2024.40.3.179.

Esthetic restoration of maxillary anterior teeth considering facial features in digital diagnostic wax-up: a case report

• Gong SJ
• Park SW
• Lim HP
• Yun Kd
• Park C
• Jang W

• KMID: 2562762
• DOI: http://doi.org/10.14368/jdras.2024.40.3.179

Abstract

To enhance the predictability of aesthetic treatment outcomes in aesthetic prosthetic restorations, considerations must include analysis of facial features, the relationship between teeth and lips, proportions of tooth width/length, gingival form, and more. Traditional diagnostic wax-ups have limitations in considering the patient’s facial features and are unable to facilitate rapid form modifications. With recent advancements in digital technology, it is now possible to digitize the patient’s facial features in three dimensions, enabling the design of restorations that harmonize with facial features. These digital workflows not only improve efficiency but also provide patients with faster visualization of treatment outcomes, thereby enhancing motivation. Therefore, in this case, a treatment plan is devised to utilize digital diagnostic wax-ups considering the patient’s facial features for the final prosthetic design.

Keyword

diagnostic wax-up; esthetic prosthesis; 3D virtual patient

Figure

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  Fig. 1 Initial intraoral photographs. (A) Frontal view, (B) Left lateral view, (C) Right lateral view.

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  Fig. 2 (A) Panoramic radiograph, (B) Standard radiograph.

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  Fig. 3 Aesthetic analysis. (A) Dental axis analysis, (B) Gingival line analysis.

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  Fig. 4 Extraoral photographs for esthetic analysis. (A) Frontal view. Left canted incisal plane, discrepancy between facial midline and dental midline, (B) Lateral view. Upper lip to E-line (-2 mm), Lower lip to E-line (-2 mm), 91.4° nasolabial angle, (C) Smile photo.

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  Fig. 5 (A) Superimposition of CBCT and intraoral scan file, (B) Superimposition of Facial scan file, (C) 3D virtual patient.

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  Fig. 6 (A) 4-unit diagnostic wax-up, (B) 1.5 mm discrepancy between facial midline and dental midline.

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  Fig. 7 (A) 5-unit diagnostic wax-up, (B) No discrepancy between facial midline and dental midline, (C) #13=12=21=22 5-unit diagnostic wax-up.

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  Fig. 8 Preparation. (A) Putty index for reduction guide, (B) Intraoral photo of pre-fabricated provisional restoration.

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  Fig. 9 Modifying the transitional line angle. (A) Frontal view, (B) Lateral view.

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  Fig. 10 Staining the distal side of transitional line angle (A) Before, (B) After, (C) White line: Movement of transitional line angle, Red line: Adjust convexity through staining.

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  Fig. 11 Intraoral photo of final restoration.

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  Fig. 12 Extra-oral photo of patient with final restoration. (A) Frontal view. Incisal plane parallel to inter-pupillary line, average smile line, (B) Lateral view. 94.3° Nasolabial angle.

Reference

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