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Figure 2 Figure 3<br />
Case Planning and Diagnostic Wax Up<br />
“The case from hell” would be the best way to describe Figure 2, which<br />
shows the problem aesthetically. Ideally, orthodontic treatment would be used<br />
initially to move the teeth into their optimal positions over time, however, often<br />
patients are unwilling to wait or accept this treatment plan.<br />
This patient was not a suitable case for implants, so we decided to go ahead<br />
with another option of tooth replacement - a bridge. As you can see, the lateralised<br />
canines are almost in the middle in between the centrals and the first premolars.<br />
This means that I had to change the proportion and the position of the<br />
teeth significantly. I had hoped that the position of the bridge separations would<br />
not be on the abutment of the lateralised canines. Unfortunately, I found out<br />
later that this would be the case. As a result, the difficulty of the case increased.<br />
There is a limitation with what the clinician can do and what the technician can<br />
do on this type of case and it could be called “a compromised case” for this reason.<br />
This does not of course preclude trying your best.<br />
In this case, the patient is a 44-year-old female hairdresser from the UK with<br />
concerns for the aesthetics of her upper teeth. In her words, she “desperately<br />
wants an attractive smile”, however, had found selecting an “enthusiastic” dentist<br />
that could deliver the desired result difficult.<br />
When approaching highly aesthetic cases such as this, I typically use diagnostic<br />
wax-ups to avoid most of the guess work. Once you start guessing, problems<br />
that could be corrected easily early on, start to compound. The minimum<br />
information the clinician should provide for creating the diagnostic wax-up is:<br />
1. Indication of the number of units and position of the teeth<br />
2. Patient’s profile<br />
3. At least two photos (See Figures 3 and 4) - a full face photo with a natural<br />
smile and a close up of the lips. Smile design is based on the essential soft<br />
tissue detail. The full face photo is utilized to determine:<br />
a. Ideal Mid-Line<br />
Figure 4<br />
Figure 5<br />
Figure 6<br />
<strong>LVI</strong> VISIONS • JANUARY • FEBRUARY • MARCH • APRIL 2008 41
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