When it comes to re-creating a patient’s smile, it is not as simple as placing veneers or crowns on teeth that are whiter and brighter than the patient’s existing dentition. The smile is an important reflection of one’s self along with communicating a variety of emotions to those around us and it is unique to each individual person.

This article provides an overview of the case of a 35-year-old male patient who worked in the cruise industry and was willing for smile designing treatment in a definitive time period as he had to go back to work post-vacation. There were many factors that were carefully evaluated in creating a smile that is esthetically pleasing to the doctor and the patient. Even after a digital simulation of a patient’s final smile, there are many principles that must be evaluated by the treating dentist.

In this case, creating an ideal smile as desired by the patient required a combination of orthodontic and cosmetic dentistry. Thus indirect restoration is going to be the part of the final treatment plan that was consulted in the early phase of treatment planning, involving the dental technician, thus helping to address and execute the treatment plan for the patient in a phase-wise manner.

After having a proper discussion with the patient the planned treatment was started accordingly after a  thorough review of the patient’s medical and dental history, a comprehensive dental examination is completed, including a proper radiographic assessment.

Any significant dental treatment that includes proper documentation of the patient’s smile with the help of photographs is important. This is the extra-oral and intra-oral pre-operative radiograph of the patient showing mal-positioning of the teeth, with the presence of diastema.

The facially generated aesthetic treatment plan is developed which involves the aesthetic analysis of the case. The smile must complement the facial features, both vertically and horizontally. This helps in developing tooth positions aligned with parameters specific to a particular face thus complementing the full facial aesthetics.

The intra-oral esthetic analysis reveals a disharmony linked to the presence of mesiodens, a supernumerary tooth, along with the presence of a mal-positioned lateral incisor. The severity of the case indicates orthodontic support at first, followed by a phase of prosthetic rehabilitation.

Understanding the patient’s needs a digital smile comparing the before and after images giving a brief idea about the final results was designed for him accordingly.

Following proper evaluation of tooth proportions and proper length to width ratios as designed digitally the orthodontic treatment was started. Keeping in mind the volume required for future prosthetic rehabilitation which the patient wanted to finish within a short span of 3 months as he wanted to return back to his work, the malpositioned mesiodens and the lateral incisor were extracted and the orthodontic brackets were bonded.
  

Space consolidation is started and this process of space closure was continued along with canine traction for achieving proper alignment of teeth for the future prosthesis.

The required space for prosthetic rehabilitation was gained with the help of orthodontic treatment following which the brackets were debonded and the retention wire was placed as shown in the image below for holding the tooth in the desired position until the replacement with the prosthesis.

Using the treatment plan as the guide the tooth preparation was done very conservatively following the principles of tooth preparation with the left central incisor and canine. The digital impression for the prepared tooth was then made with the intra-oral scanner.

Brief about intraoral scanner:

• An intraoral scanner is a device that is used to capture a direct optical impression by projecting a light source onto the area to be scanned.
• The use of an intraoral scanner is a faster and more comfortable experience for patients.
• They provide the benefit of digital accuracy and reduce manual errors.

Following this immediate computer-aided design/computer-aided manufacture(CAD/CAM) fabricated temporary crowns having a superior fit and better strength were delivered to the patient.

3D models are then printed with the help of the digital impression. This 3D printing is a faster, cleaner, and simpler process.

After having a brief discussion with the patient regarding the material of choice for the final restoration, zirconia crowns were fabricated with the help of these 3D models.
Advantages of zirconia crown for front teeth:

• Zirconia was the material of choice as it offers better strength and durability.
• As zirconia is strong it does not require much tooth preparation/ cutting thus preserving the natural tooth structure.
• Also, zirconia is the material of choice because of its good longevity and biocompatibility, which means it is less likely to provoke any inflammation.
• The product is 100% metal-free, thus preventing gingival darkening and removing the possibility of exposing metallic margins if gum recession begins.
• Layered zirconia is more translucent, naturally esthetic, and can easily match the shade of the adjacent teeth.

Following the intermediate step of bisque trial/ trial smile which was performed for ensuring the functional stability and shade, preserving the continuity in the form, function, and position the final, polished zirconia crowns were placed in situ.

Required bite adjustment was made maintaining proper over jet-overbite providing balanced occlusion.
 

The patient was very much satisfied with achieving the desired final results with a charming, attractive smile. When asked for a feedback post-treatment the patient posted as follows:
"I had my treatment done this year and I must tell you this is the dental solution clinic. Dr. Rohan is a master in his crafts, no matter if it's crowding in teeth, spacing, root canal, smile makeover, braces anything he has a solution for everything. He understands the patients, and their queries n offer solutions keeping in mind your budget & timeline. I’m highly grateful to him & very happy with his service. His entire team is professional. If you’ve any issue pls visit him once & I'm sure you won't be disappointed. When it comes to smiling you can place your complete trust in Dr. Rohan Virani."