Kunal Rai presents a case report of a smile makeover using an align, bleach and contour approach.
A patient in her mid-twenties presented unhappy with her gummy smile.
She said she didn’t like her front teeth pointing outward and the shade/shape of her top teeth, which were affecting her self-confidence. No acute pain was reported.
She wanted to have her teeth treated but was unprepared to have fixed braces at her age. She sought to have braces that were invisible and did not regress her confidence further.
Furthermore, she wanted to have composite bonding to improve the edges of the teeth.
Case assessment
The patient’s last dental visit was more than 12 months prior due to the Covid-19 pandemic. She was referred to the practice through a friend.
As part of any assessment, we started by discussing the patient’s main concerns, which helps build a rapport with her so she felt at ease. We then moved on to discussing her medical and social history.
The patient was generally fit and well, taking no medication and no known allergies. Alcohol consumption was moderate and she was a social smoker.
Her oral hygiene was good, reporting that she brushed twice daily with an electric toothbrush and flossed occasionally.
The preoperative photographs are shown in Figure 1 and Figure 2. The results of the extraoral and intraoral examination are summarised in Table 1.
| Face |
Normal lower face height Upper midline coincident; lower midline shifted to the right class II skeletal base Lip catch present |
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| Smile |
High smile line Deficient buccal corridor Mesial of upper canines are prominent |
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| Function |
Canine guidance in excursive movements Healthy and asymptomatic TMJ |
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| Dentition |
Multiple restoration on the LLQ Attrition and worn incisal edge of the anterior teeth Wisdom teeth: PE UR8, UL8, LL8 [distoangular], LR8 [distoangular] |
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| Periodontal status |
Fair oral hygiene: minor inflammation and calculus present, thick gingival biotype |
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| Occlusion | Sagittal | Right | Left |
| Incisal | Class II div II | ||
| Molar | CL II sub-unit [25] | CL II sub-unit [25] | |
| Canine | CL II sub-unit [50] | CL II sub-unit [50] | |
| Overjet | 1mm [UR1 and LR1] | ||
| Vertical | |||
| Overbite | Increased approx 50% | ||
| Transverse | |||
| Crossbite | UR6 | ||
| Space analysis | |||
| Upper arch | Mild/moderate crowding | ||
| Lower arch | Mild crowding | ||
Table 1: Assessment summary
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