Esthetic rehabilitation of anterior teeth with orthodontic treatment and porcelain veneers

Cases with large diastemas are challenging. The prosthetic closure of gaps with wider teeth is limited by a length/width ratio of 85%, which is the widest ratio that is still perceived as esthetic for central incisors. The orthodontic closure of gaps is limited by arch form and patient bite. In these cases, a combined orthodontic and prosthodontic approach is necessary to achieve an esthetic and stable result. Thorough treatment planning in such cases is essential. However, it is also challenging, as orthodontic treatment is never completely predictable.

The following case was solved by a combination of orthodontics and prosthodontics, along with tools used to predictably achieve the desired result. 

This patient's chief complaint was dissatisfaction with their smile's esthetic appearance due to diastemas. Prior to consultation, the patient had visited multiple dentists and orthodontists who said that predictable treatment was not feasible. Additionally, tooth #21 (FDI) / #9 (US) was discoloured due to an accident suffered several years earlier. Furthermore, the lower teeth presented diastemas and rotations.  Medical history was unremarkable.

Treatment procedures were carried out as follows: First, root canal treatment on tooth #21 (FDI)/ #9 (US) (a non-vital tooth) was completed. Additionally, the tooth was internally bleached with 35% hydrogen peroxide during one week. The upper anterior teeth were provisionally widened using composite resin. This simplified the orthodontic treatment as the treatment goal shifted from an even distribution of spaces, which is challenging to achieve, to a simpler closure of the open spaces. Following this provisional restorative treatment, orthodontic treatment was carried out until the desired position of teeth was achieved. Once all teeth had been aligned, the upper incisors and canines were prepared for porcelain veneers. Provisional restorations were fabricated on the same day. Finally, laminate veneers, constituting the definitive prosthesis, were facbricated and bonded.