smile design

[kpuniabv]

I saw this patient for a smile consult this week

His main concern is the crown Ur1 wich he feels looks out of place
He was not ware of the gingival asymtery until I have pointed it out to him

He has a marked cant to the right. I have mentioned 2 possible options, orthodontic ging aligment and then 6-8 units anteriorly, or crown lengthening URQ and then anterior porcelain work

I would be interested to hear any other opinions on how people would manage this case

Thanks

[TifQureshi]

Personally I think this has to be a fixed ortho case.
I doubt you would need 6-8 units after but if you do, they could be ultra minimal if the patient went down that route.

I think the crown lengthening then ceramic work would be pretty aggressive

I think ortho then edge bonding to harmonise tooth length, then replace crown,

tif

[TimBradstockSmith]

Crown lengthening will only ever follow the axial inclination of the existing tooth roots so if they are canted, the gum lift will follow the roots at an angle. Also the higher you go the narrower the tooth becomes, so the gingival shapes become more 'pointy'. So it can be hard to achieve a balanced result in a heavily canted case and any crown lenghtening above 2mm will really be obvious. With this in mind I would definitely recommend prealignment. If your orthodontist cant resolve the cant 100% and crown lenghtening is still required then at least it would be on straight teeth, improving the result no end. This would also make any ceramic work still required much more conservative.

[kpuniabv]

This is a similar case to one I have asked advice on before. I'd just be interested in any feedback on smile design, and my suggested approach to the case

My preliminary treatment plan is to use Invisalign to correct lower arch crowding and intrude ULQ to improve gingival symmetry and reduce gummy smile and the cant ULQ, also try to upright UL1 a little,as it looks mesially inclined?

Then review re porcelain or composite bonding to correct incisal contour.

Many Thanks

Kirrin