Show Your Work: A Combined Digital Orthodontic and Restorative Approach by Dr. Andrew Culbard, BDS MJDF RCS Eng, General & Cosmetic Dentist

Advances in cosmetic orthodontics and digital dentistry, coupled with a change in mindset toward prioritising the preservation of tooth structure, has led many patients presenting for cosmetic solutions for their smiles to undergo a multi-disciplinary approach.

This 21-year-old patient presented for cosmetic improvement of her teeth. In her own words, she wanted a ‘wider and brighter smile with bigger teeth.’

These clinical issues presented:

• Starting shade was A3.
• Peg laterals and canines in the upper arch, with a generally anaesthetic tooth morphology throughout.
• Spaced upper arch with a lack of symmetry and some minor rotations on the canines.
• Lower arch had mild crowding.
• Gingival zeniths were uneven, with some recession and a lack of keratinized tissue.

The treatment plan was based on a facially driven smile design, with calibrated images measured against the Invisalign ClinCheck software. The benefit of using a digital system here was to allow for accurate positioning of the anterior teeth for minimal preparation and the ideal restorative outcome (Figs. 1a–1f).

A seven-week Invisalign programme allowed for enough movement in the upper arch while resolving the mild crowding in the lower arch. The final tooth position can be seen in Fig. 1f.

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  Figure 1a

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  Figure 1b

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  Figure 1c

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  Figure 1d

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  Figure 1e

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  Figure 1f

Postorthodontic provisional retention was implemented with removal Essix retainers, which were used for home whitening of the upper and lower teeth. A final shade of BL3 was achieved while the lab created a diagnostic wax-up guided by the smile design.

A putty matrix was used to transfer the wax-up to a trial smile (Fig 2).

Once the trial smile was approved by both patient and dentist, the acrylic was used as a guide for crown lengthening on the UR2, and then as a preparation guide for the APT technique (Fig. 3).

A decision was made between dentist and patient that the areas of recession would be left with a supragingival margin; the patient declined a grafting procedure.

The final restorations from UR4 to UL4 were created from pressed E.max and cemented using Variolink Esthetic LC?neutral. Finally, definitive Essix retainers were constructed for retention.

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  Figure 2

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  Figure 3

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  Figure 3 continued

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  Figure 3 continued

Before and after