Before and After Archives - Smile Virtuoso

Before and After 2021: Smile Design 2.0 (Part 1) – Performing a smile makeover for dental professionals

Apr 08. 2023

I’ve been meaning to work on my publications for a while but was occupied with my GAMSAT studies, plus the establishment and stabilisation of my new business - Smile Virtuoso, in Pyrmont, NSW. It’s been a year and a half since I updated my blog posts, and now I finally have an opportunity to work on some exciting projects to share and be published in 2023! I want to kick off the blog post in this Before and After section, titled ‘Smile Design 2.0 (part 1 and part 2)’. These blog posts serve as sneak peeks of the cases presented in my upcoming article, where I present a standardised protocol in smile design, explaining the requirements in digital photography and communication...

BEFORE AND AFTER

Before and After 2020: Missing Tooth Replacement on Lateral Incisors (Part 2)

Jun 18. 2021

A Caucasian male patient in his youth was introduced to me upon a failure of the previous Maryland-Bridges on 13-11, 21-23. The restorations only lasted for a few months (done by another technician), and I couldn’t identify its cause or never given a specific reason by the treating clinician. In part 1 of the ‘missing tooth replacement’ (click here to read), I presented implant restorations in Zirconia with Ti interface abutment to replace the lateral incisors. For this case, I present more of a conservative and cost-effective option – Maryland-Bridges in lithium disilicate (e.max) for optimum bonding strength. Figs 1-2 show the pre-op condition. Fig 3 shows my standard protocol in shade taking. I make sure to use three different shade guides to identify the...

BEFORE AND AFTER

Before and After 2019: Missing Tooth Replacement on Lateral Incisors (Part 1)

May 28. 2021

A Caucasian female patient in her 20s was introduced to me upon completion of extensive orthodontic treatment to create enough space to replace the missing laterals. It has been a long journey for the patient to get to the point having the implants on the laterals and hoping to achieve the smile that she never thought was possible. There were a few technical challenges that I encountered: the angulation of the screw channels colour matching with the surrounding natural dentition. 1: Today, close to 100% of my implant restorations are requested as screw-retained rather than cement-retained. When the angulation of the implants are not ideal, then my primary choice is to use dynamic abutment – an alternative to the genuine Ti interface...

BEFORE AND AFTER

Before and After 2018: Smile Makeover – Replacement of Existing Restorations

May 14. 2021

A Caucasian female patient in her 40s flew in from Switzerland and stayed in Sydney, Australia, over the Xmas break for the smile makeover. Her existing veneers were only done 4-5 years ago by another technician, and she was unhappy with them due to being over contoured. The treating clinician modified the shape clinically before sending the patient to my studio for a smile design consultation. Thus, her condition was close to ideal, and she was happy with them in general. My job was to identify where we can improve and determine the number of units required to achieve the best possible outcome. Figs 1-3 show the pre-op condition. Upon detailed discussion, I observed the following information. Shape: As noted above, the treating clinician improved...

BEFORE AND AFTER

Before and After 2017: Smile Makeover – Achieving Super-bright Life-like Restorations

Apr 23. 2021

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...

BEFORE AND AFTER

Before and After 2015: Smile Makeover – Replacement of 2 Teeth on 1 Abutment with Pink Ceramics

Mar 12. 2021

A Caucasian female patient in her 20s was just about to get married and wanted to look the best. She was missing laterals with vampire-like fangs that bothered her. Because of the timeframe, orthodontic treatment was not an option. Since the teeth are all vital, we need to be conservative in prep generally, but the aggressive prep is necessary where required. Boding strength is another element we must consider. Thus, we decided to go with lithium disilicate (e.max) restorations – veneers on the central incisors and first-premolars, with joint crowns to replace the laterals and canines off one abutment for each quadrant. Fig 1 shows the pre-op condition. When working a case like this, the communication between the clinician and technician is...

BEFORE AND AFTER

Before and After 2014: Smile Makeover – Addressing Mid-line Cant and Proportion with Lateralised Canines

Mar 05. 2021

A Middle Eastern female patient was concerned about her smile’s asymmetry, cased by the midline cant and shift with missing laterals. The lateralised canines are as wide as the central incisors, so the overall proportion needs improvement. It is not visible in the initial smile photo, but the patient has a gummy smile, which she would like to address simultaneously. When working on a case like this, initial planning is crucial to visualise the outcome from the beginning, and thus, diagnostic wax-up is a must. We have decided to idealise the gingival level by crown-lengthening/gum-contouring, to begin with, then lithium disilicate (e.max) veneers from 13-23, right upper canine to left upper canine, a total of 6 teeth. Figs 1-4 show the pre-op condition. The...

BEFORE AND AFTER

Before and After 2013: Smile Makeover – Implant Zirconia Bridge with Gum Porcelain

Feb 19. 2021

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...

BEFORE AND AFTER

Before and After 2012: Smile Makeover – Achieving Significant Change in Proportion with porcelain veneers

Feb 05. 2021

A Caucasian male patient in his 30s was deeply concerned about the aesthetics of his smile. There are several issues we had to address: most notably, changing the proportion and tooth size within the aesthetic zone, crown-lengthening/gum-contouring, and a replacement of a missing tooth on 14 (right first-premolar). We selected a Zirconia bridge on 15-13, and lithium disilicate (e.max) veneers for the rest – 12-26 (missing 25), from the right second-premolar to the left first-molar, a total of 10 units. I must admit that this case was one of the most challenging smile makeovers I had encountered at that time, but the result spoke for itself. The patient was “over the moon” with the outcome. The key to achieving such a result was...

BEFORE AND AFTER

Before and After 2011: Setting a Benchmark in Digital Photography

Jan 29. 2021

A male patient in his 30s presented with the aesthetic concerns on the gummy smile and prominent hypocalcification on the central incisors. Hypocalcification is a condition where your tooth’s enamel has an insufficient amount of calcium. When this happens, the enamel still covers the tooth’s surface but parts can be thin and weak, giving teeth an opaque or chalky appearance. We decided to proceed with crown-lengthening, to begin with, and lithium disilicate (e.max) veneers on the central incisors for the better blend with the rest of natural dentition. Figs 1, 3 and 5 show the pre-op condition. Figs 2, 4 and 6 show after completion of the crown-lengthening for the upper arch. See the consistency in the provided photos – retracted view,...

BEFORE AND AFTER

Before and After 2010: Treatment of Cleft Lip and Palate – a “Pro-bono” Smile Makeover

Jan 08. 2021

A female patient in her early 20s presented with congenitally missing upper lateral incisors, and one canine, a total of 3 teeth seeking a fixed replacement. The patient has a cleft lip and palate bilaterally, which has been treated several times over the years with surgery to repair it. Implants are not possible as there is no bone in the surgical repair sites, and in fact, she still has an oro-nasal communication. The patient had limited resources to pay for treatment and hoped that the federal Cleft Lip and Palate Scheme would cover the costs, which turned out that only extractions and dentures are eligible for the claim. Thus, the treating clinician – Dr Michael Mandikos and I had decided to treat...

BEFORE AND AFTER

Before and After 2009: Soft-Tissue Management at the Socket on Pontic Sites

Jan 01. 2021

A Caucasian male in his 70s had presented with failed roots on the lateral incisors (12 & 22). The patient was also concerned about the aesthetics of the overall smile, wanting to have a youthful look. We commenced the case with 2 x Zirconia bridges 13-11 & 21-23. Fig 1 shows the pre-op condition. 12 and 22 were extracted, and the soft tissue was managed during the temporary stage by the treating prosthodontist. Fig 2 shows the remarkable state of the soft tissue recovery. Communication in the shade taking is essential between the clinician and ceramist. The shade tab should be placed edge to edge position, as shown in Fig 3. Fig 4 shows the completed Lava zirconia bridges (13-11 & 21-23). Note...

Technical/Clinical Tips & Tricks

CORRECTION OF MIDLINE CANT WITH A SINGLE CENTRAL INCISOR

Jan 01. 2021

The primary objective of treating a single central incisor is to create a restoration that blends in with the surroundings. The two front teeth - upper central incisors -are the most dominant part of the smile, and they are used to determine the position and cant of a facial and dental midline. Studies suggest that the most important relationship to evaluate the aesthetics is the mediolateral inclination of the maxillary incisors. If the incisors are inclined by 2mm right or left, laypeople regard this as unesthetic. Figs 1 & 2 show a trauma case with damaged right upper central incisor – 11. The assessment of the facial midline can only determine with a full-face photo; however, the images suggest enough to indicate...

BEFORE AND AFTER

Before and After 2008: Welcoming my Inaugural Patient at Smile by Yugo

Jan 01. 2021

A Caucasian male in his 30s presented with a trauma case on the (patient’s) right central incisor (11) – had an accident while playing football. He was also concerned about the appearance of the (patient’s) right lateral incisor (12) – it appears too short and narrow in his words. 11 is a non-vital tooth with minor discolouration in the stump (c.f., Fig 1); thus, we selected a zirconia restoration. The opacity of Lava Zirconia was suitable for slight masking, and its aesthetic advantage in complex colour matching. 12 is a healthy, vital tooth clinically speaking (c.f., Fig 1), thus we required only a minor conservative prep to proceed with the refractory veneer. Additionally, bleaching was completed two weeks before the shade taking...