Esthetics with inadequate overbite overjet
Attractive middle aged female presents for cosmetic consultation, desiring veneers. Noted 0 mm overbite w 2 mm. of over-jet. Moderate to advanced anterior attrition secondary to posterior excursive interferences in protrusive and balancing excursions. Zero restorative space. DSD projection includes adding approximately 2 mm. of length. Anterior slide from centric relation to centric occlusion of 1 mm.
Considering (1) cosmetic contouring and gingivoplasty to "lengthen" the anterior teeth, (2) orthodontics to lingualize lower anteriors and buccalize upper anteriors in an effort create appropriate overbite/over-jet and then restoring with veneers. ((This option concerns me as the teeth will be come more prominent during orthodontic movement and again if veneers are additive in an effort to keep bonding limited to enamel)) (3) opening the vertical and full arch reconstruction, (4) running away.
I can gain 1 mm of over-jet by equilibration but feel that would be inadequate as the restorative space would still be limited and this pt. probably requires a long centric. Wax-up and mock-up is pending.
How have you handled this challenge? All plans would include occlusal equilibration and a nighttime orthotic.
Thank you for reviewing and for your opinions!!