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ePaper created 2016-03-29, 15:23:51 | version 1.38.0
| case report shaping the gingival contour 12 cosmetic dentistry 1 2016 Crown lengthening has been widely used for im- proving the contour of the gingival line.9–11 However, even if the contour of the gingival line could be modified through periodontal surgery from the vertical direction, the palatally inclined maxillary anterior teeth would cause the inclination of the teeth’s long axes in the sagittal direction. Therefore, the ideal aesthetic outcome would be difficult to achieve (Fig. 5). In this case, the restoration’s entire labial face needed to be shifted labially so that the height of the gingival contour could be improved (Fig. 6). Therefore, a more suitable treatment option was considered. During further examination, we found that the pa- tient had a thick gingival biotype with a 3 mm deep gingivalsulcusaroundthemaxillaryrightlateralinci- sor and maxillary left central incisor and 1 mm deep around the maxillary right central incisor (Figs. 7 & 8). In implant dentistry, when the soft tissue around the implantisofathickbiotype,modifyingthecontourof thesofttissuebyshapingthetransmucosalsofttissue with a provisional resin crown of a certain shape has been proved to be an effective method for improving the aesthetic outcome.12–15 However, for restoring defective natural teeth, there is insufficient clinical evidence to prove whether provisional resin crowns are capable of shaping the gingival contour. Such a treatment protocol was deemed worth attempting in the current case. Diagnostic wax-up Inordertopreviewtheexpectedoutcomeandguide the treatment, a diagnostic wax-up was prepared. On the model, the incisal edges of both central inci- sors were located on the palatal side of the red line (wet–dry border) of the lower lip; hence, the position of the incisal edges was to be shifted 2 mm to the labial side. Furthermore, in order to improve the pa- tient’s deep overbite and large overjet, we decided to shifttheincisaledgesofthemaxillarycentralincisors by 2 mm in the vertical direction, where the lip–teeth relationship could still tolerate changes palatally. According to the varied gingival sulcular depth, in ordertoprotecttheconnectiveepitheliumofthegin- gival sulcus, the top of the gingival line of the maxil- laryrightlateralincisor,maxillaryrightcentralincisor and maxillary left central incisor would be shifted in the apical direction by 2.5 mm, 0.7 mm and 2.5 mm, respectively. The entire restoration would be inclined to the labial side by 1.5 to 2 mm so that the palatally inclined roots would not interfere with the aesthetic outcome (Figs. 9–14). Fig. 19: The provisional restorations placed in the mouth. Figs. 20 & 21: The gingiva was covered by the labial side of the provisional restorations. Fig. 22: The gingiva was covered by the labial side of provisional restorations (diagrammatic sketch). Fig. 23: The provisional restorations appeared just as if they had erupted from the gingival sulcus (diagrammatic sketch). Fig. 24: Two weeks after placement of the provisional restorations, the gingival contour had begun preliminary remodelling and the margin of the abutment teeth had been exposed. Fig. 25: Gold alloy cast post and core. Figs. 26 & 27: The second provisional restorations with advanced gingival contour remodelling. Fig. 25 Fig. 26 Fig. 27 Fig. 19 Fig. 20 Fig. 21 Fig. 22 Fig. 23 Fig. 24 dentistry 12016