Amazing result Ross. Did you change the incisal position very much or was all of the length increase accomplished with crown lengthening? I'm sure you addressed an implant for 9 with the patient, what was the thought process for choosing a bridge instead? Cases with facial asymmetry can be very challenging and you handled it incredibly well. Thanks for setting the bar so high!
Rodrigo De Marco
Excellent as usual Ross ! You showcase the integration of CEREC / digital technology with Spear concepts ver well - thank you for doing that.
Spear and Cerecdocs go very well together. It's like cookies and milk !
Looking forward to next month's Live Patient Seminar and seeing similar cases and workflows.
As always, I appreciate the feedback and questions. Allow me to take a stab at answering them...
@James - She has an asymmetrical smile (patient's left side rises higher) and hypermobile upper lip (she has about 10-12 mm of dynamic movement). On top of that, we had some gingival rebound on the left side after the crown lengthening. I truthfully didn't pick it up until the final photos, but since the hard tissue was clearly adjusted by the periodontist to the correct level relative to my provisional crown margin, I should be able to do a touch-up gingivectomy to idealize the margin position and improve the left to right symmetry. Per your last question, I did not have to re-prep after healing since the tissue actually healed a little coronal to where I had planned it in the provisional/gingivectomy step.
@Daniel - I did not change the incisal position, so as you surmised, all the "length" came from the apical crown lengthening. As for the implant in #9, she opted against it because the incisive canal would have had to be enucleated and grafted. We instead did a connective tissue graft there to bulk up the pontic site and allow me to do a true ovate pontic design for #9.
@Rodrigo - Lab bench only with photos for reference. I'm glad to say there were zero fit issues or adjustments, but I did change the cusp position for #6 and 11 by adjusting intraorally prior to final seating. I also did the final glaze chairside after try-in because I found it very tricky to get the correct amount of lavender/grey tint on this very opaque BL2 LT substrate.
@Karen - I did not perform the crown lengthening in this case, although sometimes I do. I anticipated needing the connective tissue graft to bulk up the ovate site #9, so I sent her to my favorite periodontist to do that and the crown lengthening. He did a nice job, but we did get some rebound on the left side, as I mentioned before. It should be easily correctable, though with a little trimming.