before
after
This case as you will see addressed all aesthetic challenges possible in our profession. We find in
everyday modern day dentistry implants although better suited are sometimes not always the best
solution. With this patient factors to consider were: already had 20 years of functionally successful bridge-work in the upper arch
 had explored implants but due to high smile line we could not guarantee an aesthetic result as the
tissue defects were large
 please consider tissue colour in this case as it does vary from one photo to the next and you will
see that in fact in the posterior left hand quadrant of the upper arch with little light the tissue
photographs better but in the upper right hand quadrant in the anterior region tissue colour varies
in the photographs but on the whole is a good match
 there would be a compromise on contour in the anterior tissue region to accommodate for hygiene
and cleaning
material used for this case include: Renishaws’™ zirconia single units and bridge units
 GC Gradia™ soft tissue replacement
 Vita VM9™ zirconia porcelain
before treatment
before treatment
upper and lower teeth
frontal view
1:2 magnification
naturally retracted gingival display
Teeth to be replaced 16, 15, 14, 13, 12 and 11, in one
zirconia bridge 21 and 22 single zirconia units
23, 24, 25, 26 and 27 in another zirconia bridge (these
bridges were milled in Renishaws’™ material)
note the: deficiency of tissue around 11, 12, 13 and 14
 deficiency of tissue around 26
 irregularity of gingival heights
before treatment
upper anterior teeth
left lateral view
1:2 magnification
naturally retracted gingival display
teeth to be replaced 16, 15, 14, 13, 12 and 11, in one
zirconia bridge
note the: emergence profile shows the need for tissue
contouring and replacement
 incisal edge contours and incisal lengths too long
before treatment
maxillary anterior teeth
right lateral view
1:2 magnification
naturally retracted gingival display
note the: emergence profile helps as a visual reference for
labial face facets
 incisal edge contours and incisal lengths and
irregular gum heights
before treatment
maxillary anterior teeth
1:2 magnification
frontal view
retracted
before treatment
maxillary arch
occlusal view
1:2 magnification
note the: tissue defect and span of bridges
during treatment
gauging occlusal orientation
1:1 magnification
non-retracted
during treatment
upper and lower teeth
frontal diagnostic try-in, in-situ view
1:1 magnification
naturally retracted gingival display
translating diagnostic in the mouth showing incisal curve,
without contrasting device
note that: how the cant of the anteriors was duplicated from the
orange stick and putty
 decided to perform gingivectomies on 21, 22 and the premolars to improve gum smile line
 this also allows us to lift the occlusal table and reduce
crown length to width ratio of the centrals
 made temporaries from diagnostic that was done on the
preps themselves
one month after proper treatment
upper and lower anterior teeth
frontal view
1:2 magnification
naturally retracted gingival display
note that: we aimed for the Golden Rule
 tested patients tissue tolerance and ability to clean at this
stage
 gingivectomy performed
before treatment
mandibular anterior teeth
lateral view
1:4 magnification
Vita 3-D™ 1M1 tab without contrasting device
note the: value showing contrast to the natural teeth clearly
before treatment
lower teeth
frontal view
1:4 magnification
retracted
Vita 3-D™ 2M2 tab without contrasting device
note the: correct value
during treatment
lateral view
1:4 magnification
retracted
taking tissue colour for composite tissue replacement
during treatment
lateral view
1:4 magnification
retracted
taking tissue colour for composite tissue replacement
three months after proper treatment
maxillary anterior teeth
frontal view
1:2 magnification
retracted
bridges and crowns in place with gingival display
note the: final emergence profiles of the crowns 21and 22
 21 and 22 had to be slightly bigger to fill the space
between vital 23 and mid-line
 23 is a bridge anchor
before treatment
upper anterior teeth
left lateral view
1:2 magnification
naturally retracted gingival display
teeth to be replaced 16, 15, 14, 13, 12 and 11, in one zirconia
bridge
note the: emergence profile shows the need for tissue contouring
and replacement
 incisal edge contours and incisal lengths too long
after treatment
maxillary anterior teeth
right lateral view
1:2 magnification
naturally retracted gingival display
note the: emergence profile
 soft tissue replacement above 25 and 26
 23, 24, 25, 26 and 27 are a bridge
incisal edge contours and incisal lengths and irregular gum
heights are corrected
after treatment
upper and lower teeth
frontal view
1:2 magnification
retracted gingival display
teeth to be replaced are 16, 15, 14, 13, 12 and 11, in one
zirconia bridge 21 and 22 single zirconia units
23, 24, 25, 26 and 27 in another zirconia bridge (these bridges
were milled in Renishaws’™ material
note the:



papilla
reduction in crown length by 3mm
smile line
regularity of gingival heights
after treatment