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smile design case

  • 1.  smile design case

    Posted 05-10-2019 02:17:00 PM
    Hi everybody:
    This patient would like to close her diastema. I see that she has a reverse smile and I am thinking that it may be better for her to have orthodontics first in order to lower her occlusal plane and then possible veneers or the closure of the diastema.
    If she opts for no ortho. Would veneers only allow for a good result on this case? I would appreciate your input on this.
    Please see attachments

    Yami Pate

    Yami Pate DDS
    Bentonville AR
    (479) 254-8111

  • 2.  RE: smile design case

    Posted 05-11-2019 10:58:00 AM
    Good Morning Yami.
    Wow, what a potential for super conservative dentistry - if this woman's smile and occlusion can be adequately enhanced/improved via orthodontics(Invisalign) and low/slow whitening with zero restorative.
    Then, again if she desires additional changes after orthodontics, it may only require minor bonding.
    Certainly a great opportunity to be conservative and have great long lasting results. 👍
    Steven Andreaus.

    Steven Andreaus DDS, AAACD
    Raleigh NC
    (919) 546-9011

  • 3.  RE: smile design case

    Posted 05-11-2019 01:31:00 PM
    I really appreciate you all comments on this case. Here are the retracted and occlusal views. Thanks so much


    Yami Pate DDS
    Bentonville AR
    (479) 254-8111

  • 4.  RE: smile design case

    Posted 05-11-2019 11:07:00 AM
    Hi Yami, great case!

    Would you be able to post some additional photos (retracted and occlusal)? I think Orthodontics will be a great option for her. From your photos, it looks to me like her centrals are a good size, but she may have a tooth size discrepancy at the laterals (need more photos though). Is she class I? She has an anterior cross bite and minimal horizontal overjet at the canine on the left. It would be interesting to see what the work up would be with some Invisalign. She may need some composite/porcelain veneers on the laterals rather than the centrals!

    Marina Ambridge DDS
    The Smile Institute
    Peoria AZ
    (623) 937-1888

  • 5.  RE: smile design case

    Posted 05-11-2019 12:51:00 PM
    This looks like a great case and definitely will upgrade her smile.

    I think using Ortho first would keep the case more conservative and using a bleaching system like KOR would brighten things up.

    If if she declines Ortho, I think I would consider porcelain veneers on 7-10 to equalize the spacing and the size discrepancy of the laterals. They appear diminutive to me and could be larger especially when you close the space around 8 and 9. Thanks for posting.

    You will do great!


    John Kenney DDS, FAGD
    Tupelo Smiles and Cosmetic and Family Dentistry
    Tupelo MS
    (662) 840-1535

  • 6.  RE: smile design case

    Posted 05-11-2019 04:51:00 PM

    Hi Yami, 

    That's a nice case from a dental point of view, but depends of what the patient wants.

    It can be done extremely conservative.

    If she wants only to close the diastema, immediate results, low expenses, than I would do direct bonding or "no prep" veneers (…with a question mark…). Patient most likely has interference on 2.1 and from the picture, she seems to have already some composite there. Depends on  the occlusion in dynamic, models, clinically and decide with her.

    Best regards,

    Cristian Parascan , DMD, CDT

    Cristian Parascan DMD, CDT
    Saint John, NB
    (506) 633-9009

  • 7.  RE: smile design case

    Posted 05-13-2019 07:49:00 AM
    Hi Yami. I think this patient's parafunction needs to be addressed as part of the diagnostics and eventual solution to her concerns.  Her lower anterior crowding and lateral/protrusive bruxism has contributed to the reverse smile and she has uneven wear on incisal edges of the centrals.  Also the existing bonding does not give a perfectly clear understanding as to the true shape of these teeth and maybe should be removed first as I think the diastema may be bigger than it looks.  Great case!

    Eric Hanson DDS
    Hanson Dental
    Pittsford NY
    (585) 248-2494