Aesthetic and functional smile enhancement using digital occlusion equilibration & dental GPS smile designing concepts-A clinical report

The application of principles of aesthetics to the natural or artifi cial teeth and restoration is dental aesthetics (GPT 1999). Aesthetic dentistry is characterized primarily by the smile. The goal in aesthetic dentistry is to achieve or create a natural dentition with a beautiful smile. Smile designing can be achieved either by restorative, orthodontic, periodontal approaches or a combination approach.


Introduction
The application of principles of aesthetics to the natural or artifi cial teeth and restoration is dental aesthetics (GPT 1999). Aesthetic dentistry is characterized primarily by the smile. The goal in aesthetic dentistry is to achieve or create a natural dentition with a beautiful smile. Smile designing can be achieved either by restorative, orthodontic, periodontal approaches or a combination approach.
A proper diagnosis of the case gives a proper guideline for treatment planning and achieving the results of patient's desire.
https://www.peertechz.com/journals/global-journal-of-medical-and-clinical-case-reports Citation: Abichandani  The prognosis is favourable after scaling and root planing with restoration of optimal health. Prognosis is favourable after the replacement of old veneers and restoration of smile.

Treatment:
Options presented To patient

Treatment sequence
Patient's Bite analysis was carried out with T-Scan to remove any prematurities which was found to be in relation to tooth 16 ( Figure 3a). Periodontal probing was carried out to identify the probing depth and if any gum corrections would need osseous recontouring as well (to maintain the biological width). A complete set of photographs were taken alongwith diagnostic casts mounted on a semiadjustable articulator using a facebow record. Two sets diagnostic impression was recorded with a combination of putty consistency elastomeric impression (Affi nis, COLTENE) and light body consistency elastomeric impression (Affi nis, COLTENE) was taken with double mix -single stage technique.
The patient's occlusal pattern was noted before the waxup for the upper front 10 teeth [3].
Oral prophylaxis was carried out in the form of scaling & root planing. Composite fi llings was done on the occlusal surface of 17 and pits in the cingulum area in relation to 22,12.
Since the patient was highly apprehensive as to how she would look, we decided to use Dental GPS concept for getting the patient acceptance & commencement of the treatment (  Figure 3). Since the dimension ratio of present veneers were not appropriate and the patients smile line extends till the premolars, patient accepted, consented for ceramic veneers from 15 to 25 alongwith gingivectomy in relation to 11,13,15,21,23,25. The previous veneers were carefully sectioned & removed to prevent any inadvertent loss of tooth structure. On examination, it was seen that tooth preparation was aggressive and patient had sensitivity in few areas of her teeth. The sharp areas of the tooth preparation were fi nished and polished (no further tooth preparation was carried out) ( Figure 6).  Temporaries) technique (Galip Gurel's Concept for evaluation of function, esthetics and phonetics) (Figure 7).
The patient loved the new look and was now confi dent that her new smile will be better than the existing one [4].
On subsequent recall, the look and function was acceptable without any discomfort or complaint. The tooth preparation was carried out through the temporaries for minimally invasive dentistry protocols to preserve the enamel and be as conservative as possible (after placement of retraction cords) in tooth reduction (Figure 8). 2 nd set of retraction cords (Ultrapak, Ultradent) impregnated with hemostatic agent (Racestyptine solution, Septodont) were then placed into the gingival sulcus and elastomeric impressions were taken. Irreversible hydrocolloid material was used for a check cast impression and provisionals (Cooltemp, COLTENE) were fabricated, checked for its fi t, occlusal interference, esthetics, phonetics, trimmed, polished and cemented (Temposil, COLTENE). Final Impressions were taken with Elastomeric impression materials ( Affi nis, COLTENE). Shade selection was done (VITA toothguide 3D-Master, VITA) and temporaries refabricated and spot bonded.
Ceramic layering was done for the incisal one-third of the veneers with a combination of enamel shades, translucent for maintenance of the oral hygiene instructions (Figure 11).

Discussion
Since the underlying tooth colour wasn't planned to be changed, we opted for minimal thickness of monolithic lithium disilicate ceramic veneers with an incisal cutback for incorporation of mamelons and incisal translucency. Dental GPS is not only a simulation software but helps us use the 2D image for 3D planning and execution with precision and accuracy with the usage of printable M lines. It was imperative to win the patient's confi dence after the previous veneers disheartened the patient completely, so a test smile using aesthetic prevaluative temporaries played a key role.

Summary and conclusion
Dental GPS is not only a simulation software but helps us