Function Trumps Aesthetics – How to Achieve Both in a 10 unit Smile Design
Patient 39 year old female presented at consult with desire to esthetics in her maxillary arch and desired a wider, brighter and longer smile. She was unhappy with color, collapsed appearance in the buccal corridor and the chipped, and asymmetrical appearance of her teeth.
A diagnostic wax up was developed with Gold Dust Dental Lab. Functionally the deep overbite required that we consider opening the patients VDO in order to protect the ceramics and not restrict her envelope of function. #7-10 were severely deflective and required that it be brought out. Gingival heights and zenith of #8 and 9 required modification with laser to idealize the gingival architecture and provide slightly more length for aesthetics.
If we just idealized length without a change in vertical, we would have steepened the overbite and potentially unchanged the overjet relationship. The result would leave the patient at risk for phonetic issues, fracture of the newly placed ceramics, and muscle fatigue, as well as other functional issues. Canine guidance was achieved and patient was opened 1mm on upper arch. Esthetics achieved using e.max HTBL1 ingot with cut back and layered porcelain. Shade selection was a bright OM2/OM1.
Consideration must always be given to the functional issues that present when a patients desires may collide with longevity of the case. To learn more, check out Clinical Mastery Series Ultimate Occlusion Level 1 Live program as well as Ultimate Occlusion Level 1 Online
By Dr. Paul Lee, Houston, TX
CMS Aesthetics Faculy