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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 affect 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 feels 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.
Table 1: Assessment Summary
Normal lower face height
Upper midline coincident; lower midline shifted to the right, class II skeletal base
Lip catch present
High smile line
Deficient buccal corridor
Mesial of upper canines are prominent
Canine guidance in excursive movements
Healthy and asymptomatic TMJ
Multiple restorations on the LL
Attrition and worn incisal edge of the anterior teeth
Wisdom teeth: PE UR8, UL8, LL8 [distoangular], LR8 [distoangular]
Fair oral hygiene: minor inflammation and calculus present, thick gingival biotype
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