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

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...

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

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...

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

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...

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Before and After 2016: Smile Makeover – Full Mouth Reconstruction with a Heart-warming Testimonial

A female patient in her 50s was referred to me for a consultation, who literally got ‘hit by a bus’ in an accident. Multiple facial reconstruction and surgeries had been performed, yet she was dissatisfied with the dental work provided.   After a lengthy discussion with the patient and the treating clinician, we decided to restore her brand-new smile with confidence by performing a full-mouth reconstruction. There were existing implant restorations from 12-22 – the right lateral incisor to the left lateral incisor, replaced in Screwed-Retained Implant bridge. The rest to be done in lithium disilicate (e.max).   Fig 1 shows the pre-op condition. The patient’s lower lip was still hanging down at this point (due to the trauma), and thus she showed more...

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

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...

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

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...

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

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...

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Before and After 2011: Setting a Benchmark in Digital Photography

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,...

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