Dental arch restoration: ceramic restorations and smile midline correction

A patient came to us for professional hygiene and complained of mild pain in the lower right jaw area. During the examination we found that the pain was caused by a wisdom tooth. The opposing tooth above it was constantly traumatising the mucosa near the angle of the lower jaw, so we recommended removing both wisdom teeth.

During the detailed diagnostics we noticed one more feature. The upper jaw already had a zirconia crown with a cantilever element that imitated an extra tooth. Because of this the dental arch looked unnatural: it effectively had an "extra" tooth, and the midline of the smile had shifted to the right.

The patient admitted that this made her shy about smiling broadly and asked whether the situation could be corrected.

We proposed the following treatment plan:

perform professional hygiene of the oral cavity;
remove the wisdom teeth;
make a digital scan of the upper jaw and create a mock-up of the future smile;
restore the aesthetics of the upper teeth with e.max ceramic restorations and correct the midline.

The treatment consisted of the following stages:

        1 ЕТАП
        
Examination. Treatment planAfter a clinical examination and detailed diagnostics we confirmed that the pain was caused by the lower wisdom tooth and that its antagonist was traumatising the mucosa. Separately, we assessed the condition of the old restorations in the upper jaw and the cantilever restoration on tooth 23 that was disrupting the proportions of the dental arch.

        2 ЕТАП
        
Professional hygiene. Wisdom teeth removalWe performed professional hygiene of the oral cavity and removed both wisdom teeth, which were causing pain and traumatising the mucosa.

        3 ЕТАП
        
Digital smile design (mock-up)We carried out a digital scan, took photographs of the smile and developed a mock-up so that the patient could see the future result even before treatment began. We then transferred the mock-up directly into the mouth and assessed the new proportions of the teeth and the position of the midline. For a harmonious result we included ten upper teeth — from 15 to 25 — in the treatment zone. This scope allowed us to correctly adjust the shape of the dental arch and restore the symmetry of the smile.

        4 ЕТАП
        
Preparation. Temporary restorationsAfter trying on the mock-up the patient fully approved her future smile, and we moved on to the main stage. We removed the old restorations together with the cantilever element, prepared the teeth, made temporary restorations and fixed them in place until the laboratory stage was complete.

        5 ЕТАП
        
Fixation of permanent restorationsTen days later we placed the permanent e.max ceramic restorations: a single crown on tooth 23 — the very tooth that previously carried the cantilever restoration — and ceramic veneers on the remaining teeth in the treatment zone. The space previously occupied by the cantilever was evenly redistributed through the shape of the new restorations.