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Case Study
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Recreating an Aesthetic Smile: Multidisciplinary and Metal-free Approach Using CAD/CAM Technology

Learning Objectives:

This case presentation describes the multidisciplinary restoration of aesthetically compromised dentition in the anterior region. Upon completing this case report, the reader should:

  • Recognize the periodontal, implant, and prosthetic considerations involved in developing natural aesthetics.
  • Understand the role of treatment planning in restorative success.

 

Prosthetic rehabilitation of anterior teeth is one of the most demanding tasks facing clinicians. Often, teeth not only require prosthetic rehabilitation using crowns, bridges, or veneers; periodontal therapy may also be required to address aesthetic, biological, and prosthetic concerns. The gingival tissue has a relevant role in determining a satisfying result of the treatment. A healthy gingiva that displays appropriate contours is a key factor to achieving an optimal aesthetic result.

Restorative and periodontal elements such as the incisal length, plane, profile, and display, in conjunction with tooth shape and color, tooth-to-tooth proportions, gingival architecture, and gingival display should be considered in the creation of an aesthetic smile. A harmonic combination between the gingival tissues and the dental restoration will result in improved aesthetics. Gingival health and color, interdental closure, gingival line zenith, gingival level equilibrium, and interdental contact levels are fundamental criteria to evaluate oral aesthetics. To achieve ideal implant aesthetics, correct implant position and ideal hard and soft tissue volume around an implant can guarantee a stable functional and aesthetic result. 

Contemporary aesthetic materials allow clinicians to deliver extraordinary results, particularly when the soft tissues are healthy. A team approach that includes the clinician, laboratory technician, and the patient is required to achieve desired results when a multidisciplinary approach is indicated.

The aesthetic rehabilitation of a patient with a functionally compromised dentition frequently involves a multidisciplinary approach. Proper performance of different phases of the treatment plan and the use of appropriate materials guarantee aesthetic and functional success. This clinical case demonstrates a successful multidisciplinary approach to recreate an aesthetic smile in a young patient with functionally and aesthetically compromised anterior maxillary dentition.

 

*Private practice, Cattolica, Italy.

  

Related Reading:

  1. Studer S, Zellweger U, Schärer P. The aesthetic guidelines of the mucogingival complex for fixed prosthodontics. Pract Periodont Aesthet Dent 1996;8(4):333-341.
  2. Fradeani M. Analisi Estetica. Approccio sistematico al trattamento protesico. Vol 1. Chicago, IL: Quintessence; 1994.
  3. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant relationship on esthetics. Int J Periodont Rest Dent 2005;25(2):113-119.
  4. Vigolo P, Fonzi F, Majzoub Z, Cordioli G. An in vitro evaluation of titanium, zirconia, and alumina procera abutments with hexagonal connection. Int J Oral Maxillofac Impl 2006;21(4):575-580.
  5. Zarone F, Sorrentino R, Vaccaro F, et al. Retrospective clinical evaluation of 86 Procera AllCeram anterior single crowns on natural and implant-supported abutments. Clin Impl Dent Relat Res 2005;7(Suppl 1):S95-S103.
  6. Shillingburg HT Jr, Kaplan MJ, Grace SC. Tooth dimensions—A comparative study. J South Calif Dent Assoc 1972;40(9):830-839.
  7. Pontoriero R, Carnevale G. Surgical crown lengthening: A 12-month clinical wound healing study. J Periodontol 2001;72(7):841-848.
  8. Gargiulo AW, Wentz FM, Orban B. Dimensions and relations of the dento-gingival junction in humans. J Periodontol 1961;32:261-267.
  9. Richter WA, Ueno H. Relationship of crown margin placement to gingival inflammation.  Prosthet Dent 1973;30(2):156-161.
  10. Magne P, Perroud R, Hodges JS, Belser U. Clinical performance of novel-design porcelain veneers for the recovery of coronal volume and length. Int J Periodont Rest Dent 2000;20(5):441-457.
  11. McLean JW. Evolution of dental ceramics in the twentieth century. J Prosthet Dent 2001;85(1):61-66.
  12. Fradeani M, Redemagni M, Corrado M. Porcelain laminate veneers: Six- to12- year clinical evaluation—A retrospective study. Int J Periodont Rest Dent 2005;25(1):9-17.
  13. Dumfahrt H. Porcelain laminate veneers. A retrospective evaluation after one to 10 years of  service: Part 1—Clinical procedure. Int J Prosthodont 1999;12(6):505-513.
  14. Simonsen RJ, Calamia JR. Tensile bond strength of etched porcelain (abstract 1154). J Dent Res 1983;62:297. 
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