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Inside Dentistry
April 2024
Volume 20, Issue 4

Conservative Treatment to Improve Function and Esthetics

Pre-restorative orthodontics and soft-tissue management enable placement of virtually no-prep veneers

Amanda Seay, DDS

Patients turn to us for professional advice regarding treatment that aligns with their best interests. As clinicians, our role is to offer patients solutions that meet their esthetic goals while ensuring that the treatment provided does not pose additional risks. Challenges can arise when patients are hesitant to undergo recommended treatments, forcing us to decide whether or not to accommodate their wishes in another manner, even if it involves removing more tooth structure, compromising tooth integrity, altering the bonding substrate, or impacting the long-term predictability of the results.

The patient in this case report expressed concerns about the thinning and wearing down of her anterior teeth as well as erosive lesions on the cervical necks, which had previously been bonded with composites. Her desire was to prevent the occurrence of further wear while enhancing her smile through restorative dentistry. Because she had an edge-to-edge bite, retroclined maxillary teeth, and collapsed buccal corridors, addressing this case without orthodontics would necessitate opening the vertical dimension, which would lead to the treatment of more teeth and involve preparation designs to wrap porcelain over occlusal surfaces and functioning cusps, resulting in further reduction of tooth structure.

The patient agreed to undergo pre-restorative orthodontics with clear aligner therapy to establish the correct functional position and allow for veneers with virtually no preparation. The orthodontic plan took the desired thickness of the restorative material into consideration, ensuring an additive approach. After uprighting the teeth and managing their spacing in accordance with the intended smile design, the patient underwent a 3-month retention period, during which records were acquired, a smile wax-up was completed, and she whitened her teeth.

Although restoration primarily focuses on white esthetics, or those of the teeth, it is crucial to consider pink esthetics and address the gingiva and the lips framing the smile. The patient in this case had generally pleasing gingival heights; however, slight crown lengthening was required for the premolars, and the gingival scallops of the maxillary anterior teeth were opened to alleviate the narrowness of their cervical necks. The soft- tissue alteration was performed on the same day, and the bone alteration was completed after placement of the provisional restorations.

Following an evaluation of the patient's tissue health and approval of the smile design, records were sent to the laboratory for the fabrication of the final porcelain veneers. The final restorations, which were seated two at a time under rubber dam isolation, met the patient's expectations and improved her function while respectfully conserving her tooth structure.

About the Author

Amanda Seay, DDS
American Academy of Cosmetic Dentistry
Clinical Instructor
Kois Center
Private Practice
Charleston, South Carolina

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