Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-03-29, 15:23:51 | version 1.38.0
shaping the gingival contour case report | 13 cosmetic dentistry 1 2016 Tooth preparation and provisional restoration According to the diagnostic wax-up, two silicone indices were fabricated. One of the indices was cut in the labiolingual direction to guide the preparation of theabutmentteeth.Themarginoftheprostheseswas designedtobeplaced0.5mmsubgingivally(Figs.15– 17). The provisional restorations would be fabricated according to the other silicone index, in which the improvement of the aesthetic outcome could be ob- served clearly. However, the shape of the provisional restorationswasnotdesignedtoemulatetheerupted natural teeth, but for the cervical part of the resto- rations to cover the labial gingiva. After a long period of remodelling and reshaping, the form of erupted natural teeth would be established (Figs. 22 & 23). The impressions for the post and cores were taken at the same time. Because the restorations were labially inclined, a gold alloy post and cores was chosen. Shaping the gingival contour The patient attended a follow-up two weeks after placement of the provisional restorations. At that time, the intra-oral examination showed recession of thegingivaandexposureoftheshouldersonthelabial side of both tooth #21 and tooth #12 (Fig. 24). The margins of tooth #11 could also be observed and the gingivawashealthy.Atthisappointment,thepostand cores were placed and further tooth preparation was carriedouttoshiftthemarginsintheapicaldirection. The new provisional restorations were fabricated to increase the convexity of the cervical part in order toenhancetheeffectofthegingivalcontourshaping. In accordance with the patient’s wishes, the incisal edges of the crowns were extended slightly by about 1 mm (Figs. 25–27). After another two weeks, the patient returned to our clinic and examination found that the gingival contour had changed noticeably and the reconstruc- tionofthetransmucosalgingivalcontourwasalmost complete. The gingiva around the restorations was healthy (Fig. 28). The transgingival parts of the re- storations were modified and the incisal edges were shortened in keeping with the patient’s wishes. Two weeks after the new provisional crowns had beenplaced,thepatientreturnedtoourclinicforfur- thertreatment.Atthattime,thepatientexpressedher satisfaction with both the gingival contour and the position of the incisal edges (Fig. 29). Once the provi- sionalcrownshadbeenremoved,thegingivalcontour Fig. 28: Two weeks after placement of the second provisional restorations with advanced modification. Fig. 29: Four weeks after placement of the second provisional restorations. The gingival contour and the shape of the crowns were satisfactory. Fig. 30: Once the second provisional restorations had been removed, the ideal gingival contour could be observed. Fig. 31: The gingival collars of the abutment teeth. Fig. 32: Regular shoulders did not form around teeth #12 and 11. Fig. 33: The restorations showing remarkable transgingival convexity. Fig. 34: The transgingival contour of the restoration was closely matched to the gingival collars on the model. Fig. 35: Restoration showing remarkable transgingival convexity. Fig. 36: The transgingival contour of the restoration was closely matched to the gingival collars on the model. Fig. 28 Fig. 29 Fig. 30 Fig. 31 Fig. 32 Fig. 33 Fig. 34 Fig. 35 Fig. 36 dentistry 12016