Before and After 2013: Smile Makeover – Implant Zirconia Bridge with Gum Porcelain
An Asian patient in her 40s was depressed about the aesthetics of her smile. She had several attempts to replace the restorations to achieve natural aesthetics, which she found difficult. She was looking for “a durable, functional and, most of all, a beautiful smile” in her words.
The treatment plan is to replace the existing restorations – 12-22 Screw-Retained Implant Bridge, and crowns on the canines – 13 and 23. To maintain the same property and material in the superstructure, we decided to use Zirconia with Ti interface abutment for the implant connections.
Fig 1 shows the pre-op condition. The aesthetical and functional issues we need to address are:
- correction of the midline cant
- achieving a sense of symmetry on the central incisors
- balanced gingival levels
- minor modification of the overall proportion
- rounder/softer style/shape (that the patient prefers)
- reduction of prominence incisally
- better canine guidance
Fig 2 indicates the base colour the patient likes – BL4 in Bleach shade guide form Ivoclar, with warmer canines (around A1.5) for the better blend against the first premolars.
Using Photoshop helps the case planning and visualisation with better communication amongst the team (Fig 3).
Around this time, I came up with the Aesthetic Articulator concept (later got granted with an innovation patent) and started applying the innovative technique to actual cases. With this, we can mount the photographed working model mounted precisely on the smile photo for better visualisation during the fabrication process. Thus, it allows a virtual try-ins of the restorations before sending the case out to the clinicians or the actual/physical try-in of the restorations in the mouth (click here to read the article).
Figs 4-7 show the creation of blueprint before moving onto the designing of the sub-structure (i.e., Zirconia framework).
Fig 8 shows the completed restorations, and Fig 9 is the restorations in situ. It is evident that we successfully achieved the natural aesthetics the patient was after, and she is thrilled with the outcome!
I’d like to thank Dr Tony Au from Dental Specialists Turramurra in Turramurra NSW, Australia, for his clinical excellence. https://www.dentalspecialists.com.au
This case was issued in December 2013 with porcelain addition.