No-Prep Porcelain Veneers and Smile Lift: Rejuvenating a Smile After Enamel Loss
No Prep Porcelain Veneers
MS D presented with considerable enamel loss in the upper arch at such a young age.
High smile with general discolouration has been a major concern for Ms D.
Treatment: Smile rejuvenation
The aim was to improve the display of maxilla (upper arch) using porcelain veneers to improve: tooth shape, colour, display, arch form & shape to complement facial aesthetics of this lovely patient
This study will show;
- Complexity of treatment. Hence specialist intervention is required as precise outcome is critical in this complex smile outline
- Treatment outcome
- Patient’s assessment
- Please refer to the video provided
Initial Presentation
Patient is in public relations, healthy fit and happy. Dietary acidity has resulted in extensive loss of enamel. The discolouration is due to dentine showing through remaining thin enamel
Now we have a unique opportunity to improve on the diagnosis & design of proposed treatment plan:
The difficulty here is minimal enamel present and the degree of discolouration (due to dark dentine showing through the thin enamel) and extent of smile line: wide smile and display if 12 upper and lower teeth during smile and speech dynamics.
Therefore, the direct diagnostic composite mock is critical in formulating how we design these restorations for an optimal aesthetic outcome and mi.
Chief concerns: improving the aesthetic apperance of her smile:
- To improve the general discolouration, tooth shape/shade & form and improve the arch width..
- This lovely socilite patient wants to smile understanding the complexity and the precison of the work required.
Diagnosis: Unacceptable tooth colour display, and narrow upper arch: creating an aesthetic disturbance
Enamel loss in the upper arch at such a young age. Note the translucent enamel present. We have lost about 3mm of enamel.
Diagnosis & Patient centred treatment planning
Once we have determined their needs and expectations and when the patient is ready, we begin to restore their teeth to optimal function and aesthetics.
Diagnostic Mock Up
Diagnostic: mock-up & assessment. Finalise degree of tooth showing during smile & speech dynamics, maxillary arch form & smile width.
We tested the diagnostic mock up for patient acceptance that guided the final desired aesthetic outcome.
Treatment
Following with discussion of all risks and treatment modalities with our patient that included;
No treatment: this is not an option as we have considerable discolouration and enamel loss from an acidic diet
Repair existing restorations and gum lift: this is a temporary measure and not accepted by the patient
Porcelain veneers/onlays: best long-term solution, Fixed option: accepted by the patient
Our Aim: to improve the aesthetics of upper arch: Gum level, tooth shape, display, tooth colour, length, symmetry and smile line in general along the upper arch involving 12 maxillary teeth porcelain veneers.
This was accomplished with minimal discomfort to the patient and using no tooth intervention. No provisional veneers were required, since the existing composite veneers placed by the author 15 years ago required no tooth intervention. Therefore, the tooth enamel is intact and helped in the gum healing process following gum lift.
Procedure & Results
Diagnostic: mock-up & assessment. Finalise degree of gum and tooth showing during smile & speech dynamics, maxillary arch form & smile width
Impressions for porcelain veneers
Lower arch tooth in-house whitening
Issue the porcelain veneers
Procedure
Ultrathin minimal intervention
Patients tooth was not invaded and note how thin the porcelain veneers are 0.2mm
This was developed by Dr Nalbandian and his laboratory over the last 20 years
The work was completed in two visits. In general it takes about 3 weeks from diagnosis to final outcomes.
We tested the diagnostic mock up for patient acceptance that guided for final desired aesthetic outcome.
Porcelain veneers by Dr Nabandian, Creating balance and complementing on facial aesthetics: CONFIDENCE
Note how all compositional elements of teeth gums lips and face are in concert together
Aesthetic Effect : Should establish harmony and balance between dentition and surrounding soft tissues
Initial Presentation
Initial presentation
Biagnostic mock- up
Final outcome as per diagnostic mock- up
Final treatment outcome: we have restored aesthetics.
However, most importantly, we have complemented our lovely patient’s facial aesthetics.
Hence the term: dentofacial rejuvenation by Dr Sarkis Nalbandian
Its Always enjoyable to take images of this delightful patient. Most photogenic and always smiling!
The Aesthetic Effect
Should establish harmony and balance between dentition and surrounding soft tissues.
Final treatment outcome: we have a happy patient and we have restored aesthetics comfort & function.
Registered Specialist
Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)
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