Full Vertical Smile Lift

124 Rating(s).


Posted on By miguel stanley In Esthetic Therapy (General)

In this case the patient had severe wear and tear of all his teeth. His main objectives were not just esthetics, he was worried with the fact that his teeth were getting shorter and presenting fracture lines. We explain that in order to solve this problem he would need to do a full vertical smile lift. His periodontal situation was fine except for his first upper right molar which needed to be extracted. As you will see on the photos I tried to place implants straightaway however the bone was not perfect so I regenerated and waited six months. During this time we fulfilled the patient desires. We do not use digital technique here to design smile, rather opted for an old school wax up using a facial bow. We are however big fans of the digital technique also. The patient was quite happy with the bisacryl temporaries so then it was just a question of copying the design to ceramic. In posterior region we have Zirkonzahn with stratified ceramic layered and in the anterior we opted for Emax and stratified ceramic.
Regarding the implant I chose to do some osseodensification before placing the implant to improve the quality of the bone following my GBR. It worked quite well as the ISQ measurements were above average. The last photograph is on the day of cementation and that is why the gengiva is a bit inflamed. Patient was very happy with outcome. Of course these cases require good planning, hard work from the Lab and a patient that can afford this procedure.

Initial Situation
Extraction of the first upper right molar and Regeneration

Implant Placement
Provisional Phase


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9 Comments

Are those porcelain crowns or veneers in the front? The case looks great.


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Veneers on the anteriores


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Miguel; How do you decide on amount of OVD and increase and vertical dimension? How do you manage changes in OJ/OB and incisal guidance? regards Maurice


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This is a team effort and we had the lab come in and use a face now for this case as we do with most cases. Then the wax up is done in the articulador. Once we do a silicone index and a bisacryl try in to test we do a functional mock up. Patient lives with this for a week to ensure the physiological aspects are good. Only then we go to ceramics.


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Hi Maurice;
You have learned a lot about restorative dentistry.
It looks like the vertical has changed a small amount. Unfortunately, when we look at the palatal angulation of the bicuspids and cuspids, you can still see that the envelop of motion is still constricted which means that while the overbite has increased slightly, the overjet is the same.
What is the next week link? The soft tissues? The bone? The ceramics? Or mobility?
Regards,
gerald


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Hi Dr.Gerald, great points, only highly experienced eyes can notice these changes. How do you keep these teeth out from the zone of function which are in the danger zone. Regards, Ashok


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Hey Miguel,

You did a great work and patient's teeth are really looking good now.


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Very nice well done case!. Though wanted to comment as to tooth 16 solution. As 2 full coverage crowns were place due to aesthetic and occlusion reasons, why not use them for a conventional 3 units bridge (our old, good very predictable friend) instead of the implant and augmentation needed??
The debate tooth/implant is widely discussed and known by now that implant solutions are not flawless, we should consider to think all this over.......


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Really nice result, Miguel...but I want to see before and after smile photos posted please.


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