This patient had a variety of minor aesthetic issues. Her interdental papillae had receded as a natural phenomenon of aging. Her central incisors where slightly misaligned, off-color, and shaped asymmetrically. The left central incisor was to short compared to its width, leading to a square-shape look. There was a significant left-right asymmetry among all upper teeth. She also displayed discolored and deteriorating old dental restorations. The central downward curvature of the gum line was too extreme compared to the downward curvature of the inner border of the lower lip and the position and curvature of the upper lip.
The gum lift was completed right at the beginning of the treatment. After two months of healing time and tissue maturation, the teeth were prepared and received provisional restorations. They were based on a diagnostic wax-up that was fabricated by establishing all aesthetic elements to an ideal while incorporating them into masticatory function and arch form. The transferred provisional restorations were reviewed by me (Dr. Rabanus) and my patient.
While my patient focussed on aesthetic concerns and considerations, I made sure that any desirable changes were completely integrated in oral function. This process took another two weeks. Without a gum-lift surgery, this case would have been completed within two weeks. However, we wanted to make sure that the gum line had completely stabilized and would not change anymore once the permanent porcelain restorations were placed. We therefore waited for an additional month before refining the preparation of the teeth according to the established gum line and taking the final impressions.
The final consultation established the patients desires regarding shade and translucency of her permanent porcelain veneers and crowns. She shared pictures of smiles that she had found on the internet and indicated that she wanted a moderate incisal translucency with a subtle display of dental mammellons, mimicking the developmental lobes of the underlying dentin, which are typical for youthful teeth.
Our patient finally had the smile that she wished for. Her new smile looked "refreshed," healthier, and natural.