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ePaper created 2016-12-07, 11:04:42 | version 1.38.0
dentistry 4_2016 cosmetic 24 gival contour shaping. 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 re- turned to our clinic and examination found that the gingival contour had changed noticeably and the reconstruction of the transmucosal gingi- val contour was almost complete. The gingiva around the restorations was healthy (Fig. 28). The transgingival parts of the restorations were modified and the incisal edges were shortened in keeping with the patient’s wishes. Two weeks af- ter the new provisional crowns had been placed, the patient returned to our clinic for further treatment. At that time, the patient expressed her satisfaction with both the gingival contour and the position of the incisal edges (Fig. 29). Once the provisional crowns had been removed, the gingival contour around the abutment teeth was similar to the soft tissue collar around dental implants. The final impression was taken in or- der to fabricate the master model, which would replicate the gingival contour accurately (Figs. 30-32). The final all-ceramic restorations were fabricated according to the master model. _Completing the final restorations Once the final restorations had been com- pleted, the clear transgingival contours of the crowns could be seen and were consistent with the shape of the gingival collars around the abutment teeth on the master model (Figs. 33- 35). During the try-in procedure, the marginal fit, the shape and the contact points, the consisten- cy of the transgingival contours of the restora- tions and gingival collars around the abutment teeth were examined carefully. The transgingival contours of the restorations should maintain the shape of the gingiva, but not increase the pres- sure, allowing the gingiva to remain healthy and maintaining the contour in the long term (Figs. 36-39). _Revisits The one-week follow-up after placement of the final restorations found that the gingiva was healthy and stable around the crowns. When compared with the preoperative intra-oral pho- tographs, the aesthetic outcome was a signifi- cant improvement (Figs. 1, 3, 40-43). The patient unfortunately did not attend the remainder of the follow-ups until seven years after placement of the final restoration. At this appointment, the examination revealed an unde- sirable oral health status, with a Debirs Index (+) and Dental Calculus Index (++). The gingiva was mildly reddened and swol- len. However, the health of the gingiva around teeth #21, 11 and 12 was better than around any Fig. 36_The transgingival contour of the restoration was closely matched to the gingival collars on the model. Fig. 37_The final restoration seated on the maxillary anterior dental arch. Fig. 38_Left lateral view of the patient’s smile after placement of the restoration. Fig. 39_Right lateral view of the patient’s smile after placement of the restoration. Fig. 36 Fig. 38 Fig. 37 Fig. 39 case report _ shaping the gingival contour