PMC8088386_01
Extraoral and intraoral view of the severely worn dentition.
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A 71-year-old man, American Society of Anesthesiologists (ASA) type I, presented to a hospital dental department hoping to correct aesthetic and functional problems of the maxillary arch (Figure 5) where the teeth were severely worn and with the lateral incisor agenesis (Figure 6).
The panoramic radiograph showing the lateral incisor agenesis.
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A 71-year-old man, American Society of Anesthesiologists (ASA) type I, presented to a hospital dental department hoping to correct aesthetic and functional problems of the maxillary arch (Figure 5) where the teeth were severely worn and with the lateral incisor agenesis (Figure 6).
The abutment teeth were adapted to the interim restoration used as a guide for the dental preparation.
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The correct tooth proportions were achieved by preparing the distal side of the canines more than the mesial side with the BOPT and POA, so that the abutment teeth were adapted to the interim restoration and not the opposite (Figure 7).
The interim restoration immediately after the prosthetic procedure and after one month of soft tissue maturation.
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The full-arch interim restoration was positioned in the maxillary arch with the crown margin 0.5 mm subgingivally, and after one month of soft tissue maturation, the soft tissue appeared healthy without signs of inflammation (Figure 8).
The panoramic radiograph with the interim restoration showing that the dental pulp was not involved after the prosthetic procedure.
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A panoramic radiograph was made with the interim restoration showing that the dental pulp was not involved after the prosthetic procedure (Figure 9).
Extraoral and intraoral views of the final restoration after the 1-year follow-up.
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At the one-year follow-up visit, no biological or technical complications were noted, and the gingiva appeared thick, pink, healthy, and completely adapted to the definitive restoration (Figure 10).
PMC8088386_02
Extraoral and intraoral views showing deep bite and gummy smile.
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A 70-year-old healthy woman presented at a private practice dental office, unsatisfied with her smile; this was due to excessive maxillary gingival display (a gummy smile), concomitant with short clinical crowns (Figure 11). Intraoral examination revealed partial edentulism, rotated anterior maxillary teeth with incisal erosion, and enamel wear (Figure 11). The right central incisor was rotated in the buccal position, with gingival recession and loss of gingival height (Figure 11).
The mandibular arch showing the right central incisor and the second molars before the prosthetic preparation (a) and realignment after the POA (b).
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The mandibular left second molar was mesially inclined, so it was prepared more on the mesial side than on the distal one using the BOPT with the POA to move the dental axis distally, thereby creating an adequate space for the first molar parallel to the path of prosthesis insertion (Figure 12).
The mandibular right central incisor without the interim restoration: (a) gingival recession; (b) healing of the gingival recession and thickening of the gingiva after the BOPT protocol with POA.
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The POA was also used for the mandibular right central incisor by preparing it more on the vestibular side to realign it with the adjacent teeth (Figure 13).
Final rehabilitation at the two-year follow-up with the new smile after the correction of the deep bite and gummy smile.
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The dental technician was instructed to position the crown margin 1.5 mm subgingivally only on the vestibular side, using all of the available gingival sulcus, thus improving the gummy smile (Figure 14).
Panoramic radiograph taken two years after the procedure showing that the dental pulp was not involved after the prosthetic procedure.
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The procedure did not affect the pulp vitality, and no endodontic complications were observed at the 2-year follow-up (Figure 15).
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