Chief complaint

This study will show

Complexity of treatment

Treatment outcome

Patient’s assessment Please refer to the video provided

Gummy Smile & Short Teeth

Social Smile Full smile

REAL SMILE DESIGN

Diagnosis: Tooth wear and gum asymmetry in the critical aesthetic zone, creating an aesthetic disturbance

TOOTH WEAR

Initial Presentation&Chief concerns

This elagant patient initially presented for improving the aesthetic appearance of the upper

and lower teeth. The concern was further extended to overall teeth/arch shape and gum

asymmetry. The presence of extenting porcelain veneers have functioned well for considerable

time, however with time and teeth wear we felt it was time to correct the gum assymetry and

therefore tooth shape/form assymetry most evident in the aesthetic zone toward frontal area

combined with complex smile line ( where both arches are on the show during speech and

smile dynamics) is creating an aesthetic disturbance.

Clinical assessment

1. High smile line with obvious midline tooth asymmetry mainly associated with uneven wear. 2. Small teeth for the size of the arch-more related to wear.

3. Smile width over the years we have reduced buccal corridors (smile width) tis will be improved in the treatment plan to improve arch width and display.

4. Due to uneven wear we also have tooth eruption with uneven gums that requires correction to improve emergence profile of upper veneers and bilateral gum symmetry due to the complex smile line-we need symmetry and this needs to be respected in the critical anterior aesthetic zone Our Aim: create symmetry and harmony in the aesthetic zone and complement this elegant patients dentofacial aesthetics

Solution: Dr Nalbandianalways we start with diagnostic mock up (Direct Kesling set up)

DIAGNOSTIC COMPOSITE MOCK UP

Diagnostic composite mock with following improvements noted include: A. Corrected centerline B. Corrected arch form C. Symmetry across the midline D. Improved lip/facial support E. Speech & comfort improved; you felt more confident and comfortable with the new arch shape and position. G. Overall improvement in dental-facial aesthetics.

Face is dynamic: Learn to think in 3D

Diagnosis takes time

There is no recipe!

Everyone is a prototype

After all, Dr Nalbandian is theartiste!

Sculpturing your smile to suit your facial aesthetics!

Direct diagnostic mock up (Direct Kesling set up)

I don’t understand digital smile design, when the patients face is in front of you!

I am and artist, reconstructive dentist/specialist & implant surgeon

I create what is wright for you with my brain and hands and not by a computer!

I create the smile that complements my patient! Not the damned computer software!

I teach Real Smile Design to postgraduate students and dentists worldwide.

My favourite quotation

Imagination is more important than knowledge…Albert Einstein

Please refer to relevant video presentation

Direct diagnostic mock up (Direct Kesling set up) guides amount of

gum and tooth exposure we need during smile and speech dynamics

Procedure & Results The work was completed in six weeks. Gum lift 4 weeks,it is best not to rush biology and allow optimal healingand 2 weeks for the porcelain restorations. The diagnostic mock up followed by provisional restorations provided that important confidence for our patient for normative function comfort & aesthetics. We tested the new provisional restorations and refined it for patient’s acceptance that guided for final desired aesthetic outcome.

We understand that …

How we see the patient differs from how the patient sees herself!

Gum lift & full upper arch combination of 12 porcelain veneers and crowns.

Final treatment outcome: we have restored aesthetics comfort & function.

However most importantly we have complemented our lovely patient’s facial

aesthetics.

Hence the term: dentofacial rejuvenation by Dr Sarkis Nalbandian

Final treatment outcome and we have a confident and happy patient.

Dr. Sarkis Nalbandian Registered Specialist Prosthodontist & Implant Surgeon

Visiting professor YSMU

B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London D. Clin.

Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)