Patient 1

* female

* medical condition: none

* patient’s request

- get rid of her pain in the her upper anterior teeth and she wants to get her “old” smile

back (referred patient)

* 30 years

Patient 1

history: crown lengthening after 6

porcelain restoration have been placed.

Digital Facebow

November 2010

Facial Analysis

Facial Analysis

Facial Analysis

Facial Analysis Lips in Repose

+/- 4 mm tooth structure

Facial Analysis Full Smile

Lip Dynamics WNL

Dental Analysis

21 rootcanal (due to pain)13 mm

8.3 mm

x-ray’s

initial periodontal chart

Diagnosis

* iatrogenic damage to soft tissue and teeth (13-23): violation of biologic width resulting in crown

lengthening

* leakage ceramic restorations (bacteria) causing soft tissue

inflammation

* gummy smile

* long anterior teeth upper jaw

* To much tooth exposure with lips in repose / dynamic interference anterior teeth with lower

lip during smiling

* buccal corridor in conflict with anterior region

primary concerns

* how to eliminate the pain in her teeth

* How to “heal” the affected soft tissue

* How to re-establish correct tooth proportions

* How to restore her teeth long term

* How to meet her aesthetic wishes (want “old smile” back)

treatment objectives

* re-create healthy soft tissue around the restorations

* improve length-width ratio’s of her upper anterior teeth

* improve the aesthetics of her smile

* eliminate pain

* improve soft tissue positions (facially) of tooth 13-23

treatment plan

* remove old ceramic restorations* cement provisionals (13-23) with the correct l/w ratio

* re-create a new CEJ position restoratively * soft tissue healing phase

* root coverage with Allograft (alloderm) using the tunnel technique

* healing and maturation phase soft tissue (6 months)

* ceramic restorations 13-23

November 2010

March 2012 1.5 years after placement provisionals

Re- established tooth contour (CEJ-form)

March 2012

Re- established tooth contour Cemento-restorative margin

Miller Class I

periodontal re-evaluation

x-ray re-evaluation

Oktober 2013

Soft Tissue levels alterations Tunnel Technique with Alloderm

S h a d e

Smile Evaluation

re-evaluate provisionals (3 years in function)

Try inn Ceramic Restorations

4 years after start treatment

X-Photo examination