Smile of the Year – 2024 – Стоматологична клиника в Кърджали

Main complaints include unsatisfactory smile because of short teeth and too much visible gum. She requested a treatment without ortho and implants.

Clinical findings:

Asymmetry of the lips;
Gingival smile;
Deep bite; short teeth;
Multiple discoloured direct composite restorations with secondary caries;
Missing tooth 17;
Periodontal pockets in lower left and right distal area;
Moderate periodontal pockets in upper frontal teeth with underlying caries;
No TMJ disorders reported; overall unsatisfactory appearance of white and pink aesthetics.

Short summary:

I was present with an unaesthetic smile due to overexposing of the gingiva. Inequality of the gingival marginal line contributed to disproportion of the crowns. In order to make new proper form of the incisors, they needed to be elongated in apical direction. With resective surgery I was able to achieve more balanced marginal line of the gingiva reducing the excessive vestibular bone volume on teeth 12;11;21;22;34;35;37;44;45;47. I decided to go with the flapless approach because of the RELU segmentation. Even though it is not 100% accurate, it is still a good source of information. I achieved coronal position of the crowns which elongated the papilla and eliminated the gingival smile. By resective surgery I created right emergence profile of the crowns which is more effective for personal oral hygiene. The crown lengthening of both lower and upper jaw was done to effectively remove the subgingival decays and to reduce the soft tissue pockets. Final result combines pink and white aesthtics in balance with the smile line.

Treatment plan:

Orthodontic treatment
Lateral sinus elevation and implant placement and all of the mentioned in #3 or only
Flapless surgical crown lengthening with a guide on the upper jaw and non-guided crown lengthening on the lower jaw. Resto-endo treatment; new indirect restorations on all teeth, except for 26, 27.

Treatment of preference:

The preferred treatment was #3 because the patient declined orthodontic treatment and implant placement. Due to the fact that she did not agree to prep all her teeth I relied on the canine guidance and I did not prep 26, 27.

Sequence:

Initial periodontal therapy- US cleaning, Airflow, SRP
Digital planning of the new position of the teeth (DSD), motivational mock-up and fabrication of the digital crown lengthening guide
Surgery- Soft tissue resection (gingivectomy) with electrocautery pen and guided flapless bone reduction with CVD DentSurgPro with tip TR1-PK on upper jaw and non-guided crown lengthening on lower jaw both in different
appointments; bone reduction on teeth 34;35;37;44;45;47
Resto-endo phase – endodontic treatment of 13; 22; 43; 41; 31; 37 after removal of the old bridge and new composite restorations during the healing process of 12 weeks;
Preparation of the teeth on the upper jaw; digital impressions and try-in; placement of immediate temporary crowns from the mock-up (Luxatemp DMG Bis-acrylate)
Preparation and digital impressions on the lower jaw.
Delivery of the final restorations. Cementation with Glass-ionomer cement (SHOFU CX-Plus)