Indirect restorations

1 Apr 2017 - 2782

My patient Alexandra. She is 25. She came to me with the request to have beautiful, even, white teeth. I conducted the examination that revealed she had plastic crowns on her front teeth. Also the CT showed that endodontic treatment had also been done. No periapical changes were detected.  


Fig. 1

In order to decide on the treatment plan, I began with Digital Smile Design.

Fig. 2

First, micro-level analysis was conducted, forming horizontal and vertical lines.

Fig. 3

Then I proceeded to do the tooth-labial analysis, assessing the outline of the patient’s lips in relation to the horizontal lines of the teeth.

Fig. 4

The next step was height and width ratio estimation, which provided me with teeth proportions that allowed me to decide whether to lengthen teeth or not.

Fig. 5

Analysing the outline of the gums was also very important.

Fig. 6

So, based on all the analysis seen here

Fig. 7

I was able to design the ‘ideal smile’ using a calibrated ruler to make a digital Mock-up for the patient, and make all the decisions before treatment.

Fig. 8

I planned all the treatment that consisted of stages such as bleaching, surgery and prosthetics.

Fig. 9

I started with bleaching using the newest ZOOM 4 system, which allowed me to achieve the best result. In this case, by the time the work was done* the teeth were 4 shades whiter than the plastic crowns.

Fig. 10

The surgeon used our DSD to cut 1 and 0.8 mm off of the gum in 1.2 1.3 teeth area.

Fig. 11

The dental technician ( Vagram Torosyan) created the wax-up.

Fig. 12

Two weeks later we began working on prosthetics. It only took 3 Steps to put the Mock-up into the patient’s mouth. In this picture the change due to gum correction is especially apparent. Correct isolation is, in my opinion, the key part of my work. So I used Rubber Dam.

Fig. 13

Then I made a marking with the burr and pencil through the Mock-up to control the depth of preparation.

Fig. 14

All the preparation was under control of operating microscope, so that accuracy and high quality could have been achieved.

Fig. 15

Finally, I worked on keys control and tooth stumps polishing.

Fig. 16

After this came the technical stage.We presented our work to the patient.

Fig. 17

With the patient’s approval, I moved on to the fixing stage, using the same protocol of isolation and control with the microscope. We proceeded step by step preparing, working on crowns, teeth surfaces, and fixing.

Fig. 18
Fig. 19

After polymerization, we removed the excesses of the composite , and then polished the teeth.

Fig. 20

The gum had been injured and looked swollen after fixing, but appearance improved in a few days.The gum looked normal and healthy, the patient’s feelings of discomfort passed. These photos were made after a while.

Fig. 21
Fig. 22


You have to find out initial request from the patient, before you start proceeding. According to the diagnostics you may propose correct healing, comprehensive approach, then start. Its necessary to discuss all stages with other specialists and technician as well. Only like that you get predictable results and happy patients.