Cosmetic case to share with you
I started this case seven months ago and it involves different aspects of dentistry that I want to tell you about. The patient came to see me as she was unhappy with the appearance of her teeth.
As you can see from the pre operative photo there is a median diastema ( gap in between upper central incisors ) and the upper lateral incisors are small for the rest of the mouth.
We had a consultation about what she was not happy about and formulated a treatment plan. As it was only the anteriors that required movement, I decided to use Insignia, which is a clear brace system from America, which specifically moves upper first premolar to upper first premolar.
Impressions, a bite and full mouth photographs were taken and aligners were made to close the diastema. Each aligner is worn for three weeks, then we would review the progress and move onto the next one. After six months of wearing aligners the gap closed.
Aligners are made of clear plastic and fit only on the teeth, they are very comfortable and speech and general day to day activities are not affected. They must be worn all the time to complete movement, especially during the night.
Once the gap was closed, the patient had in surgery bleaching, which lightened her teeth by about 8 shades from A3 vita to 0.5M vita. She then topped this up with one week of home bleaching, as you would have read in my previous blog on bleaching, this involves wearing bleaching trays for about two hours per day with 6% hydrogen peroxide gel within them.
Then the fun appointment came! At this appointment, both the upper right and left lateral incisors were prepped on the surface by 0.3-0.5mm to create enough space for the porcelain veneers. Dental impressions were taken of both arches, shade was taken and all of this was sent to the dental lab. The porcelain veneers were made and returned after one week.
The veneers were then fitted with a special cement called nexsus. The teeth are still fragile and prone to moving back to their original position and the gap re-opening, so I fitted a wire to the backs of the upper teeth and made a night time essex retainer.
An essex retainer looks like a hard plastic mouth guard and will help to keep the teeth in the new positiom until the bone has fixed. This could take up to a few years, retention is very, very important.
This is the end result
The patient is delighted, I will review her in a weeks time and it is very important for six monthly check up and cleans as part of her maintenance program.