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ePaper created 2014-10-09, 17:54:05 | version 1.30.01
dentistry 3_2014 cosmetic24 Transverse and vertical relationships were normal (Figs. 3a-c, 4a, b). During lateral excursions, there was no canine guidance on both sides and trau- matic occlusion was present at the second molars. During protrusion, the incisal guidance was main- tained. The incisal edges of the maxillary lateral incisors were rounded, and midline diastemas were present in the maxillary and mandibular arches. _Treatment plan Combined orthodontic, prosthodontic, and implant treatment was planned, aimed at resto- ring aesthetics and function with the maximum preservation of hard tissue, while replacing the missing teeth and reshaping the maxillary late- ral incisors. It was planned to close the diaste- mas between the teeth, restore the midline in both arches and canine guidance, and gain the space necessary for one premolar on each side of the maxilla and the second premolars in the mandible. The missing teeth were to be repla- ced with crowns supported by implants, while the shape of incisors was to be changed with veneers and direct composite. _Orthodontic treatment The first stage of treatment included the orthodontic treatment to correct the lateral crossbite, close spaces in the anterior segment and restore coincidence between the midline of the maxillary arch and the facial midline. The tre- atment plan also included restoring the coinci- dence between the maxillary midline and the line between two mandibular incisors on the left side. Therefore, two incisors were left on the right side, whereas on the left side the canine was moved to the position of the missing lateral incisor. Normal intercuspation and canine guidance were achie- ved on both sides. In the mandibular arch on the left side, the left canine assumed the function of the lateral incisor and the left premolar that of the canine. During orthodontic treatment, the persistent primary to- oth was retained, to provide additional anchorage and to maintain the width of the alveolar process. _Implant-prosthodontic treatment After orthodontic treatment had been com- pleted, a new occlusal analysis was performed Figs. 9a, b_Reshaping of the two maxillary central incisors (before and after). Fig. 10_The prepared feldspathic veneers for the two maxillary lateral incisors. Figs. 11a, b_The maxillary lateral incisors before and immediately after placing the veneers, with visible gingival irritation. Figs. 12a, b_The veneers one week after cementation, showing perfect gingival integration. Fig. 9a Fig. 10 Fig. 11a Fig. 12a Fig. 11b Fig. 12b Fig. 9b case report _ biomimetic approach