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Collaborating on a Smile Makeover, from Surgery to Obsidian® Veneers

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article by Anamaria Muresan, DMD, ME, CDT, and Peter M. Scheer, DDS, M.S.


No matter the scope of your dental practice, collaboration is one of the most effective ways to set yourself apart as a practitioner. This might seem counterintuitive, but the benefits are clear as you face highly complex cases, in which multidisciplinary treatment plans stand to benefit the most from a wealth of experience, input and combined expertise. For these cases, close dialogue among colleagues allows for seamless care during complex treatments. In fact, your patients might come to feel like your practice is an extension of your colleague’s, and vice versa. Facing even the most intricate cases, with meaningful teamwork you’re poised to deliver transformative results that will position you as an elite practitioner in the minds of your patients.

Case Study

A female patient presented with concerns about her crooked teeth, gummy smile, and what she called a weak-appearing lower jaw profile. The patient exhibited shyness and had taught herself to smile with her mouth shut or a hand covering her mouth.

Upon examination, the patient’s excessive gingival display was attributed to vertical maxillary excess secondary to altered passive eruption, gingival hyperplasia, tooth malposition and unesthetic tooth proportions. Prior to treatment, the visible length of the patient’s cuspids and centrals was 7–7.5 mm from incisal edge to gingival margin — noticeably short of an ideal esthetic length of 11 mm for the cuspids and 10.5–11 mm for the centrals. Additionally, the patient was diagnosed with severe mandibular retrognathia, microgenia, crowding of anterior maxillary dentition, and underlying skeletal malocclusion.

In discussing treatment options, the patient asked to avoid a more intensive approach involving orthodontics and orthognathic surgery. The task then was to create a treatment plan that would circumvent Mother Nature, starting with a gingivoplasty and crown lengthening in the maxilla, in which the upper gum tissue and underlying bone would be recontoured. The gingivoplasty and crown lengthening were to be performed in conjunction with a genioplasty of the mandible. For the genioplasty, a silicone chin implant was considered but rejected due to concerns about lack of muscle attachment, in addition to the facial distortion seen with this type of implant. Instead, the patient’s own bone would be used to achieve a more natural and harmonious-looking result.

Moving beyond the surgical foundation for the patient’s smile makeover, Obsidian® lithium silicate ceramic veneers (Prismatik Dentalcraft, Inc.; Irvine, Calif.) were chosen for teeth #4–13. Ideal reduction was planned, with a focus on maintaining the proper biological width; proper tooth size and proportion; proper central-to-lateral-incisor-to-cuspid proportions; and the smile line and a harmonious gingival veil. To maximize the patient’s surgical time, placement of a Hahn™ Tapered Implant (Prismatik Dentalcraft, Inc.) was included for tooth #3; the tooth would then be restored with a BruxZir® Solid Zirconia crown.

Obsidian is available in VITA® Classical and Bleaching shades and can be pressed or milled utilizing CAD/CAM technology.

Conclusion

When cases require solutions beyond what you offer in your practice, meaningful collaboration with your colleagues is indispensable. Combining your skills and experiences with those of your fellow practitioners, a wellspring of dental knowledge is available to forge each treatment plan. The result is a multifaceted approach that answers the demands of highly elaborate cases and, more importantly, benefits your patients.

Chairside Magazine: Volume 11, Issue 1

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