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Fluorosis, Orthodontics, Veneers using the Digital Smile Design treatment concept

Fluorosis, Orthodontics, Veneers using the Digital Smile Design treatment concept

by Dr. Kamsiah Haider, BDS, MDSc

Multidisciplinary dentistry in management of untreated Fluorosis in an adult using ceramic veneers. Malocclusion treated with Orthodontics and Bone Screws .

The patient was a healthy 22-year-old woman leaving this country to pursue her studies overseas soon. We were given less than 6 months to complete her case.  Poor alignment and discolored were her chief complaints. The patient wanted a fuller, more attractive smile. The patient’s heightened awareness of her dental appearance led her to our practice in search of a conservative , digital smile  makeover . 

Discolored teeth

Proper case selection is critical in obtaining a natural result when treating the dentition with minimal-preparation veneers. Patients have long welcomed this concept of a long-lasting, minimally invasive procedure that favors the preservation of enamel. It cannot be overemphasized that case selection is critical in the application of this technique. This patient was initially thought to be a simple case but the lower jaw was  protrusive and we need to bulk the upper anterior dentition,  with  no-preparation or minimal-preparation may have undesirable results.  Upper teeth look too procline to compensate the lower jaw.

 

Since we tried to make this case as ideal as possible, orthodontics and bonescrews were required to give a good positive overjet and overbite in this case. The orthodontic treatment gave the position of teeth that were required   her dentitions benefited from the minimal- preparation veneers except for the two centrals which had substantial caries were crowns . The rest could be treated in combination with shade change and incisal edge restoration.

 

 

Ceramic veneers are considered a conservative solution for patients requiring improvement of the shape, color, or position of their anterior teeth. Ceramic veneers have been extensively and successfully used to mask intrinsic staining, to give the appearance of straightening, and to correct minor malformations of anterior teeth without the removal of substantial amounts of sound tooth substance. There are several methods of attaining the reduction required with the preparation: freehand, use of depth cuts/grooves (the use of depth cutters or grooves and dimples has been recommended to control tooth preparation, as the use of standardized objects allows accurate judgment of depth), and use of silicone putty index or the provisional (use of a silicone index derived from the wax-up allows a visualization of the reduction required to achieve the form and contours of the preplanned shape and length of the final veneers).

 

DSD analysis

Traditionally, composite has been the preferred treatment modality when thin restorative veneering was needed. But today, with the introduction of minimal-preparation veneers and crowns a longer-lasting and more durable result can be provided. Ceramic offers a virtually stain-free surface, permanent high luster and polish, and superior incisal edge strength, which is far greater than the microhybrid composite of today. Fabrication of crowns and veneers involves a laboratory procedure, offers more control than composite because the ceramist has several days to fabricate the restorations. 

Digital Smile Design in a partially edentulous case. Denture or Dental Implants?

Digital Smile Design in a partially edentulous case.

By Dr. Kamsiah BDS, MDSc
Prosthodontist, DSD Master and Instructor

We use DSD in Keynote to analyze this smile project. DSD has been an indispensable tool in our practice. It helps us in formulation of an aesthetic clinical diagnosis and treatment planning which is a fundamental in our approach to our patient, regardless what he opted to after presenting the case to him.

We use digital dentistry and image-editing software which are now part of our clinic’s armamentarium.

 DSD is a simple and economical way of offering the patient a predictable plan that can be visualised immediately or at least at the second appointment to demonstrate the aesthetic and functional changes possible with treatment with the aid of corresponding models.

DSD also helps me as a smile designer to communicate with the patient, the laboratory technicians and my clinical team in giving patient what we has designed and translate it to the final outcome of this case.

At the end of the day, what patient wants is a better smile as what we have shown him on the blueprint we presented. He could have these options :

A) removable partial Denture with veneers on existing front teeth
B) Fixed implant prosthesis with veneers or crowns on his existin and functional teeth.

C) A and B are only possible after we extract his retained roots and reinforce oral hygiene.

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