January - LVI Visions

is just endless and you never stop learning. And again, every case should look
different as every patient is different.
Moving onto surface anatomy, most of the time I use the natural dentition
from the pre-op model as a guide. For this case, the patient has a naturally
smooth surface anatomy so it is absolutely unnecessary to create a lot of detail
on the surface. In regard to lustre, you can see in the pre-op photos (Figures 4-
6) that it appears to be highly glossy so this is what to match. Again, this is not
about what you think would look good - it is a matter of following nature and
meeting the patient’s expectations.
Finished Restorations
As I mentioned earlier, while this is a compromised case, the result shows
that we can still manage to get a great result. The color matching among Empress
Veneers, Lava restorations and the natural dentition came out well (Figures
37 and 38). The color of the lower anterior is A1/A2 base and patient wanted
040/B1 base for the final result, hence the upper teeth appear to be slightly
whiter to meet the patient’s expectations.
There was some difficulty with the shape but it is possible for the ceramist to
control the gum condition by placing a suitable emergence profile and necessary
contour to help the gum regain from the recession. A very firm fit on the
pontic was also required. Without having any gum re-contouring, the result is
very satisfying. I received the full face photo from the patient two weeks after
bonding and you can see that interdental papilla is settled in a suitable position
(Figure 39).
I would like to thank Dr. Kaye McArthur for achieving this result with me.
Without her outstanding knowledge and skills in cosmetic dentistry, this article
would not have been possible. Many thanks also to everyone who was involved
in this article.
Feedback From Dr. Kaye McArthur,
Gold Coast, QLD, Australia
Bev’s case presented both Yugo and I with a number of aesthetic challenges,
most arising because of the drifted root positions of the canines that were now
sitting midway between centrals and premolars and positioned differently in
each quadrant.
This mid-space presentation required us to camouflage abutments that were
midway between the two teeth we wanted to replace. The gaps available made
it difficult to correct the smile by creating a more aesthetic Golden proportion
type tooth size relationship.
We were lucky that Bev has a relatively low lip line as the ovate pontic bridge
style and laser gum re contouring we would normally prefer to do in anterior
Figure 31
Figure 32
Figure 33
Figure 34
Figure 35
LVI VISIONS • JANUARY • FEBRUARY • MARCH • APRIL 2008 47