48
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CERECDOCTORS.COM
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QUARTER 1
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2016
C A S E S T U D Y
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BY ANDRE VALCANAIA, D.D.S.; GISELE F. NEIVA, D.D.S., M.S.; DENNIS J. FASBINDER, D.D.S., A.B.G.D.
anatomical limitations of the dentition and associated boney structures
can pose challenging clinical situations.
Treatment solutions may often require extensive, time-consuming options that are beyond the financial means or have little
value to the patient. However, the patient may still be interested in at least improving the esthetic appearance of their smile.
Often, doctor-laboratory communication may present a significant challenge in situations like this, especially when taking into account
the patient’s lip position during function. This case report involves such a clinical experience.
Smile Disharmony
Chairside Management of a Tooth-arch Size Discrepancy
A 68-year-old female patient presented to the Computerized
DentistryProgramat theUniversityofMichiganSchool ofDentistry
with a chief complaint of “I would like to do something to improve
my smile on this side.” The patient indicated the teeth on her maxil-
lary left anterior region. The patient had a past medical history of
cardiovascular problems including heart attack, angina and mitral
valve prolapse. The patient also had osteoporosis and chronic back
pain, and was taking Lipitor and Lovastatin daily.
Clinical examination revealed that the patient had a significant
Fig. 1 Pre-op, #s 10, 11
Fig. 2 Pre-op diagnostic model
unilateral tooth-alveolar bone size discrepancy with a 4 mm
diastema between teeth #10 and #11. The patient had previously
had the large diastema closed with direct composite restorations
that resulted in a significant increase in the mesio-distal width of
#10 and #11 relative to the contralateral teeth (Fig. 1).
The previous composite restorations were unsuccessful in
closing the space in an esthetic way. The restorations were worn
and rough, and there was evidence of marginal staining. There
was no protected excursive function on the left side; therefore the
