PMC5366210_01
Pretreatment extra and intraoral photograph and periapical radiograph. (a) Smile photograph. (b) Intraoral photograph (front view) showing a midline diastema. (c) Periapical radiograph of the lateral incisors.
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A 36-year-old female visited the Postgraduate and Specialized Conservative Dentistry Clinic of the Dental School, Prince of Songkla University, due to concern about a space between her front teeth (Figure 1(a)). The left lateral incisor was built up with a direct resin composite (Figures 1(b) and 1(c)). Gingival recession of about 0.5 mm was presented at the distolabial aspect of the left lateral incisor, resulting in gingival level disharmony (Figure 1(b)). A shine-through effect in a metal ceramic crown and cast metal post was also observed (Figure 1(b)). The distance from the estimated contact point to the alveolar bone was about 8 mm (Figures 1(c) and 2(a)).
Analysis of "pink" and "white" esthetics and the restorative plan. (a) Radiographic analysis. IDR, the interproximal distance between roots; AC-CP, the distance between the most coronal part of the alveolar bone crest (AC) and the most apical part of the contact point (CP). (b) Clinical photograph analysis. Gingival zenith (GZ) positions, level of upper incisal edge (blue line), incisal edge embrasure (IE), and deficient interdental papilla (black triangle between two teeth) after placement of adhesive restorations are shown. Hyaluronic acid filler injection is planned to fill the deficient interdental papilla.
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In addition, the diagnostic wax-up and photograph were used to facilitate communication with the patient, periodontist, and laboratory technician.  Figure 2(b) shows a final restorative plan including the all-ceramic crown for the right lateral incisor, the ceramic veneer for the left lateral incisor, and the direct resin composite build-up of both canines.
Front views of intraoral photographs of the patient's smile. (a) After placement of provisional restorations. (b) At 2 weeks after completing treatment.
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A2B, 3M ESPE) with a spot etching technique were placed (Figure 3(a)). At this point, the mesiodistal width of the lateral incisors had increased a total of 1.75 mm each. There was about 1.5-2 mm of the open gingival embrasure remaining between teeth, measured from the tip of the interdental papilla to the contact point (Figure 3(b)). During the same visit, the reshaping and direct resin composite build-up of the canines (Filtek Z350 XT shade A3E, 3M ESPE) to substitute for the lateral incisors were completed (Figure 3(b)).
Front views of intraoral photographs. (a) Before treatment. (b) Teeth preparation. (c) At 2 weeks after completing treatment. (d) At 18 months after completing treatment.
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Routine scaling and polishing were done during the 12-month follow-up.  Figure 4 shows intraoral photograph of adhesive tooth-colored restorations and the interdental papilla from baseline, 2 weeks, and 18 months after completing treatment.