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11 Apr 2018

By Aneta Grzesinska

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A conservative restorative smile makeover

Aneta Grzesinska presents her winning conservative smile makeover case from the Aesthetic Dentistry Awards 2017.

The patient was a 37-year-old female who presented to the practice requesting six porcelain veneers for her upper front teeth. Her chief complaint was loss of tooth tissue; she felt her teeth had become thin and brittle. Additionally, fillings on incisal margins of teeth UR1 and UL1 had chipped (Figures 2-5).

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The patient reported being examined and diagnosed in few other dental clinics and restoration of the upper incisors and canines was planned by her previous dentist. The dentist provided her with whitening trays and 10% carbamide peroxide gel (Pola Office), which she has been using for three weeks. She did not complain about any pain or sensitivity.

Histories and clinical findings

The patient was in good general health, with no known allergies and taking no medication. She had, however, reported heavy vomiting during her three pregnancies.

Her dental history included regular attendance to the dental clinic, a recent course of home whitening with a 10% carbamide peroxide, multiple crown restorations in the past, and no pain or sensitivity in the past few years. The patient reported using a manual toothbrush, and occasionally using whitening toothpaste. She reported flossing one to two times per week, but no interdental brush use, and occasional mouthwash use.

On examination, it was noted that the patient had soft gingival tissues in a good condition. She had a high smile line/gummy smile but had a welldeveloped habit of hiding it. A diastema and chipped irregular incisal margins of the upper and lower front teeth were noted.

Enamel erosion on the palatal and interproximal surfaces of upper front teeth with dentine exposure (anterior clinical erosion [ACE] class III) was reported, as well as palatal and lingual surfaces of the upper and lower premolars (ACE class I) and lingual surfaces of the lower incisors were observed (ACE class III). All molars except the lower wisdoms were restored with PBC crowns over 10 years previously, according to the patient, but which were not fitted properly, as metal margins were visible. The aesthetic look was altered by high opacity of the crown restorations.

Active carious lesions were diagnosed on the UL5, LL8 and LR8. The patient did not report any pain or sensitivity of these areas. The front upper incisors had chipped incisal margins and small discoloured fillings on interproximal areas. Her oral hygiene was fair – BPE 011/111, occlusion class I. No occlusal or functional issues appeared to be associated with either the anterior teeth or the occlusion as a whole.

A radiographic examination and vitality testing of the treatment-involved teeth indicated absence of pathology, recording the normal responses of healthy vital teeth. Tooth UL6 and UL7 were suggested for root canal re-treatment and crown replacement. Alginate impressions were taken and face bow record for study models (Figure 6).

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