COMPLEX CASES

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Anterior teeth are worn and shifted from a deep bite, loss of posterior support and bruxism. Diastemas have formed between teeth and both maxillary cuspids are shifted facially and downward. Analysis of gingival contours reveals teeth shifting is not as severe as it appears. This is important because restoration is limited by tooth structure which exits from the gingival areas. Restorative techniques cannot move these areas laterally, forward or back. Tooth structure above the gingival areas can be added onto or reduced to change position. Reduction of cuspid length and facial contours, lengthening of incisors and adding to facial and lateral surfaces close gaps and position teeth properly.

Maxillary incisors are lengthened to restore lost tooth structure. Lengthening is not done along the long axis of a tooth, instead, a line drawn through a point on the cingulum and a point on the lingual incisal edge is a boundary that composite should not to cross. The temporal mandibular joint guides movement of the mandible. Composite below this line interferes with normal movement is disturbing and damaging to the patient.

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The top diagram below shows existing tooth structure. The center diagram shows a projected result as determined by existing gingival contours, tooth position and tooth size. The bottom diagram shows the projected result superimposed on the existing structure. Areas outside the projected result must be reduced while areas inside the projected result must be added to. Cuspids must be shortened while incisors must be lengthened. Ideally, slight gingival modification would be done.

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Teeth are prepared and composite added. Tooth to tooth dimension is measured to achieve symmetrical results. The surface is contoured, textured and polished. Later, composite is replaced with porcelain for a long term and stronger result.

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