New smile, new life—innovative technologies and techniques can transform a smile

Case presentation

A full diagnostic workup was performed, which included a thorough examination, a full series of digital radiographs and photographs, and cosmetic imaging (Figs. 2 & 3). We had transformed another gentleman’s smile the previous week by opening his vertical dimension with a set of Snap-On Smiles. The latest technology from Dexis Imaging Software allowed us to access the before-and-after photographs in a matter of seconds, and show an actual case illustration of how opening a person’s bite through dentistry can change the appearance of the face to make it look younger and, naturally, better.

We then went through the Smile Style Guide (www.digident.com) to select the shape, P-4 (pointed canines with square-round centrals and laterals), and length combination, L-2 (laterals slightly shorter than the centrals and the cuspids), he preferred for the cosmetic image, and ultimately, for his new smile (Figs. 4–6). The digital photographs stored in the Dexis hub, in combination with his cosmetic images and the idea of a Snap-On Smile, encouraged the patient to accept the treatment for his smile transformation immediately.

Figs. 4–6: Smile Style Guide for smile design (Fig. 4). Smile Design P-4: pointed canines, square-round incisors (Fig. 5). Length code L-2: laterals slightly shorter than centrals and cuspids (Fig. 6).

We began by duplicating his existing upper denture for the wax try-in, using a kit made by Altadontics to impress the denture. Then, we poured in a bisacryl temporary material, such as Luxatemp Automix Plus (Foremost), Fill-In (Kerr), and Integrity (Dentsply Caulk). After about 40 minutes, we had a duplicate of his old denture to use as a custom tray with excellent borders.

Once the duplicate denture had been trimmed, smoothed, and tried in, we applied PVS adhesive and took a wash impression with a light body PVS, such as Splash! (Discus Dental) and Virtual (Ivoclar Vivadent). With this time-saving denture duplication technique, we were able to take a very accurate final impression upon the patient’s first appointment.

An impression of the lower denture was taken using System 2 Alginate (Accu-dent), to create a lower custom tray. To address one of the patient’s main concerns, his ‘sagging face’, we explained that his vertical dimension had decreased over time as he lost posterior teeth and ground down teeth 22 to 27 (Figs. 7 & 8). Only teeth 21 and 31 had close to the original occlusal height (Fig. 9). The patient had no desire to treat tooth 31, as he really wanted a painless solution for the time being, especially with the holiday season approaching. We took a neuromuscular bite registration with a slow-setting material (Memosil 2, Heraeus Kulzer), after a 45-minute TENS treatment with the Myomonitor, to record his ideal jaw relations.

At the wax try-in appointment, we confirmed the look and feel of the upper teeth. We then took an alginate impression of the wax try-in to oppose the Snap-On Smile. For the wax try-in and eventually the final denture, we selected aesthetic denture teeth, such as Portrait IPN (Dentsply Caulk) or Physiodens (VITA), in various shades, to create a more natural appearance. At this appointment, a PVS impression of the lower arch was also taken in a custom tray with a regular-set material like Splash! (Discus Dental) or Virtual (Ivoclar Vivadent) for the fabrication of his Snap-On Smile.

Figs. 7–14: Pre-op close-up smile (Fig. 7). Pre-op retracted view (Fig. 8). Pre-op occlusal view (Fig. 9). Final close-up smile (Fig. 10). Final retracted view (Fig. 11). Final right lateral view (Fig. 12). Final left lateral view (Fig. 13). Final occlusal view (Fig. 14).

About three weeks later, the patient returned for his quick, painless smile transformation (Figs. 10–16). The patient was delighted with his new smile, but was even more excited about the way his new smile was created. He knew that he looked older than he should, and did not wish to go the plastic surgery route. Rather, he needed to restore his face with a smile lift, which was accomplished quickly and painlessly through hi-tech dentistry!

Figs. 15 & 16: Final full-face view and final close-up smile.

By using the Snap-On Smile to restore his lower dentition, the patient now has a beautiful smile, and, more importantly, is able to experience the look, feel, and function of a more permanent solution. When he came to us, the patient was not willing to undergo total mouth rehabilitation in the near future. Now he is seriously considering a more permanent solution, when time and conditions allow. Also, his Snap-On Smile can be used as a surgical guide for implants. In the meantime, he is reaping the benefits of the smile transformation that modern dental technologies and techniques have helped to create.

Contact info

Dr Lorin Berland and Dr Sarah Kong can be reached via www.dallasdentalspa.com.