PMC6712968_01
Face photograph.
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fig1
I occlusion, but with an uneven occlusal plane and dental elements with alterations in color, size, shape, incisal wear, and gingival zenith. Initially, dental impressions from both dental arches (performed with the addition of silicone rubber; Virtual, Ivoclar Vivadent), occlusion record, and digital smile design protocol photos (DSD) were used for the case planning (Figures 1-3).
Smile with lip retractors.
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fig2
I occlusion, but with an uneven occlusal plane and dental elements with alterations in color, size, shape, incisal wear, and gingival zenith. Initially, dental impressions from both dental arches (performed with the addition of silicone rubber; Virtual, Ivoclar Vivadent), occlusion record, and digital smile design protocol photos (DSD) were used for the case planning (Figures 1-3).
Approximate view of the smile.
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fig3
I occlusion, but with an uneven occlusal plane and dental elements with alterations in color, size, shape, incisal wear, and gingival zenith. Initially, dental impressions from both dental arches (performed with the addition of silicone rubber; Virtual, Ivoclar Vivadent), occlusion record, and digital smile design protocol photos (DSD) were used for the case planning (Figures 1-3).
Radiograph aspect.
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fig4
By means of radiographs, it was possible to evaluate the necessity of strategic bone removals to redefine the supracrestal space (Figure 4).
DSD planning.
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fig5
The possibility of performing this new aesthetic planning was confirmed by radiographic and clinical examinations and subsequent mock-ups (Figures 5(a)-5(c) and 6).
Surgical index.
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fig7
A surgical guide was manufactured to increase the clinical crown (gingivectomy and osteotomy) according to the parameters suggested by the virtual design (DSD) (Figure 7).
Surgical index: lateral view.
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fig8
In order to perform surgical crown lengthening (Figures 8-11), the surgical guide was used to perform the incisions and the definition of the new gingival zeniths.
Incisions with the guide.
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fig9
In order to perform surgical crown lengthening (Figures 8-11), the surgical guide was used to perform the incisions and the definition of the new gingival zeniths.
Incisions.
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fig10
In order to perform surgical crown lengthening (Figures 8-11), the surgical guide was used to perform the incisions and the definition of the new gingival zeniths.
Final aspect.
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fig11
In order to perform surgical crown lengthening (Figures 8-11), the surgical guide was used to perform the incisions and the definition of the new gingival zeniths.
Mock up with the new gingival position.
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fig12
The patient was followed up postoperatively; because the gingival margin was stable and to avoid the inflammation process, no type of temporary material was used during the healing period. 60 days after the surgical procedure, new dental impressions were obtained, diagnostic waxing was performed under the new periodontal parameters, and a new mock-up with Protemp  4 Temporization Material (3M ESPE) bisacrylic resin was realized (Figure 12).
Vestibular guide.
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fig13
Measurements of adequate ceramic space (between 0.3 and 0.5 mm) were checked from time to time with the aid of a periodontal probe from the dental enamel to the guide (Figures 13 and 14).
Incisal guide.
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fig14
Measurements of adequate ceramic space (between 0.3 and 0.5 mm) were checked from time to time with the aid of a periodontal probe from the dental enamel to the guide (Figures 13 and 14).
Final aspect of dental preparation.
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fig15
Care should be taken to keep the tooth reduction inside the thickness of the enamel (Figure 15).