Facially driven esthetic rehabilitation and bite elevation for a patient with worn front teeth: a case report

Abstract

A facially driven rehabilitation, increasing occlusal vertical dimension (OVD) for a patient with deep bite and severely worn front teeth. Forty- year-old woman presented whose main concern was having worn maxillary and mandibular incisors, and canines. Digital smile design was applied (3Shape TRIOS Smile Design) and the upper central incisor's width-length ratio was set to 81% (initial: 100%, width: 9 mm, length: 9 mm). Following gothic arch tracing and face bow registration, OVD was increased by 3.0 mm and diagnostic wax-up (upper front- and premolar teeth; lower front-, premolar- and molar teeth) was made on casts mounted on articulator programmed to individual patient parameters. A motivational mock-up was made, followed by preparation with a minimal invasive approach. Silicone keys were used to copy the bite during optical impression taking (TRIOS 3, 3Shape) for functional digital wax-up and PMMA temporaries. After 2 months of wearing, temporaries were scanned and overlapped on a virtual model of prepared teeth using gingival, dental reference points (3Shape Dental System). Facially driven backward planning and bite elevation was performed. Monolithic final restorations (crowns, overlays, veneers) were milled (IPS e.max CAD, Ivoclar Vivadent) based on functional digital wax-up and PMMA temporaries. To reach the satisfied esthetic in the front region the presented treatment describes a conventional protocol for increasing OVD, creating a mock-up and then a digital workflow to copy the temporaries for a predictable result.