A Caucasian female patient in her 30s visited me for a consultation with temporary restorations in the mouth. She had her first set of veneers, which was about 16 years old. She recently had Invisalign, but the teeth moved out of the alignment. She is also concerned about the root exposure and uneven gingival level.

 

She had missing second premolars and wished to have a brighter smile, in fact, as bright as possible without making them look artificial. She commenced bleaching on her lower dentition to reduce the contrast. We decided to replace the existing restorations from 13-23 – right canine to left canine, and place conservative veneers on 14&24 – right and left first premolar, a total of 8 units in lithium disilicate (e.max).

 

---

Figs 1-3 show the photos of the pre-op condition provided by the treating clinician. Notably, there was no symmetry in the gingival level, and the curve of smile-line could improve. The patient felt that her existing restorations’ shape was too triangular and wished for a rounder/softer style with open incisal embrasures for more natural aesthetics.

 

---

Figs 4-6 show the temps in situ. Tatient was happy with the length and shape of them. It is typical (and encouraged) that the patients analyse how they appear at this stage because this is the final restorations’ blueprint.

 

I improved the overall shape based on the patient’s wishes and made the canines smaller (for more of a feminine appearance than the pre-op).

 

The patient was hoping to go brighter than the temps – she completed the bleaching two weeks before the consultation, and the colour is now. Her natural dentitions are relatively white (Figs 7&8) – around BL3 and Bl4 in Bleach Shade Guide (Ivoclar Vivadent).

 

The patient agreed that the four anterior teeth being base BL3, and slightly warmer canines (around BL4) for depth in colour within the arch. She also wished to have a medium level/degree of incisal translucency and characteristics with cervical warmth to match her lower natural dentition for a better blend.

---

Figs 9-12 show the completed restorations. The result proves that we can achieve natural aesthetics at white bleach shade range comfortably. It is just a matter of the communication between the dental professionals and the patient, to be on the same page at each step, and executing the outcome accordingly and precisely.

 

It is vital to eliminate any unwanted surprises or unnecessary artistic flare or ego/fixed mindset from dental professionals. I only do what’s been discussed/requested at the consultation (which I report back to the treating clinician), and utilise my expertise to follow and meet the patient’s expectations. If the patient is satisfied, then everyone is happy in the end.

 

---

Acknowledgement:

 

I would like to thank Dr Glen Baker from Jacaranda Dental in Caringbah NSW, Australia, for his clinical excellence.

https://jacarandadental.com.au

 

This case was issued in January 2017 with no remakes.

 

---