How to make this case work?

131 Rating(s).


Posted on By Lisa Ginzler In Esthetic Therapy (General)

Hi everyone. This is a case I just did today, my first upper 10 veneers. Previously we discussed doing uppers and lowers but patient decided he only wanted to do #4-10. I prepped and impressed him today, but he's coming in tomorrow for post op. I'm not sure he can handle the length. And he's moving in 2 weeks. :(

We started with 8 mm long centrals. I gave him an extra mm heightening the zeniths on the #8-9 and incisally 1 mm for 10 mm in height. We decided to only lighten his shade to A2 (starting off at A 3.5). I was able to get #7 into the arch and tried to stay in enamel for the other preps. That said, I'm not sure I set up the lower plane well enough, just evening out the incisals of #23-26 for even distribution on #8-9. It was really tough attempting to get canine guidance and achieve no occlusion on the inclines of the premolar buccal cusps in excursions.

I like the way they look, but he's lisping a bit and feels they're too bulky. He has 5 mm of OJ to begin with so I'm trying to minimize further bulkiness. I can recontour and make them less bulky and maybe reduce a mm off the incisal edges. At this point, I feel like this case is consuming me and I'm not even sure to do feldspathic (which I feel like is a gamble, even though they could be thin) or emax.

I don't want a turn a simple case into a complicated mountain, but after doing it today I feel like I didn't plan properly. All thoughts welcome.

Preop and postop
Preps

Occlusal of excursion movements
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3 Comments

Lisa; I think this case needed a little crown length on the centrals which would have provided some of the needed added length from the gingival side and helped even the gumline. This would given you the ability to shorten the central incisors and avoid the speech issues. In any case, good luck and overall nice work for your 1st time. regards Dr. Salama


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Hi Dr. Salama. Thank you, yes I agree with you. Given the short notice and short time frame it wasn't an option. But I definitely agree.


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It appears that the centrals have super erupted over time as the teeth wore just by observing the more incisal oriented gingival margins. I would want to have an idea of his habit of placing his mandible forward. I would also want to know if this is a result of occlusal innterferences or other habits. If in fact he wore the incisal edges of centrals as seen in the photos, I would want to know if increasing the length was going to be ok or porcelain will fracture.
I agree with Maurice that crown lengthening would be better than slight changes to the gingival margin. I have experienced patients changing their minds about pre op gum surgery when the restorations are placed and they want to know why there is a difference in length even if you brought that to their attention prior to starting treatment. It is a dance you don't need to take.
If guidance is missing on canines, see if you can add regular composite to the linguals of the teeth to gain disclussion, easy to do.
Best wishes!


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