Page 30 - DP Vol 17 No 4 ok

cosmetic section

SMILE DESIGNING WITH LITHIUM

DISILICATE RESTORATIONS

SANAH SAYED

In my opinion a comprehensive smile designing is incomplete with-
out taking into consideration the dentofacial features and aesthetics.
Creating the same smiles on different face shapes and personalities
is like painting with the same colours on canvas that lacks character
and soul.
In my 7 years of private practice, I have never found two patients
alike whether in terms of facial features, their job profile or person-
ality. It is therefore paramount to design smiles that blend and com-
plement the patient’s face making it more pleasant to look at.
Here I present a case of a 35 year old young mother and market-
ing executive whose job is to interview and make other people look
good from a Public Relations perspective.
Naturally, we did not want her teeth to be an epicentre going
really bright or dramatic and instead we wanted esthetic restorations
that look natural and beautiful. FIG 1: Initial Smile

SMILE AND DENTAL ANALYSIS
We analysed her existing smile that comprised of an existing metal
ceramic cantilever bridge, diastema between teeth and supra erupted
mandibular incisors. We also established that she has a high smile
line with the metal collar showing and some umbrella effect due to
the discoloured stump showing through the marginal gingiva.
The mandibular incisors had supra erupted to compensate for
the short metal ceramic restorations and also flared out opening
diastema between them. She gave us a history of trauma as a child,
endodontic therapy done twice and the 21 being extracted. There
was a buccal bone loss in the 21 region that we noted.
TREATMENT PLAN FIG 2: High smile line
We offered several plans
1. Implant in 21 region, individual crown on 11 and orthodontics to
correct the diastema. tion. Anterior protrusion and Lateral excursions were checked and
2. Lithium disilicate bridge elapsing 11, 21, 22 and orthodontics we decided to build the canine tips in composite to establish canine
3. Lithium disilicate bridge elapsing 11, 21, 22 and veneers to pro- guidance. I usually prefer to treat lateral incisors or till first premo-
vide restorative space, correct the supra eruption and protrusion lars. Involving canines can make the buccal corridor and gradation
on 31,32,41,42. The 12 was also to be veneered for symmetry. effect look completely collapsed if the canine is not shaped enough.
Functionality forms an important basis to any esthetic rehabilita- Shaping enamel to such an extent requires robust canines or ample
enamel to play with.

Article Citation TEST DRIVE
Sayed, S. (2021). Smile designing with lithium disilicate She chose plan 3 and we began with an additive mock-up. At this
restorations. stage a test drive was done and she absolutely hated it. She felt the
Dental Practice, 17(4), 30-33 teeth looked bulky so we decided to do subtractive mock-up in some
areas. The existing mock-up was arbitrarily shaped until she felt

30 Dental Practice // January-February 2021 // Vol 17 No 4