Case Presentation

(Fig 1) Preoperative smile view of a young female patient who presented for esthetic enhancement of an anterior open bite. A conservative treatment solution was requested.

The patient, a female high school senior, presented for esthetic enhancement of her smile (Fig 1). In an attempt to correct her anterior open bite, which was evident upon preoperative evaluation, she had explored treatment options that included orthodontics and orthognathic surgery. Due to her age and social pressure, the patient and her parents had elected not to proceed with such alternatives at that time. Treatment planning would have to include an immediate benefit for the patient, as well as leave open the option of undergoing more extensive restorative care in the future. Composite resin restorations were ideal for the patient and could be placed in a single visit without anesthesia.

Treatment Goals

(Fig 2) Retracted view of the patient preoperatively showed the 8.5—mm length of her maxillary central incisors.

The presence of the anterior open bite allows the clinician to use restorative materials that would not necessarily be appropriate if the case were to have normal occlusion. Goals for treatment were to avoid preparing any of the dentition, to overlay the teeth with composite that would improve form and function for the patient, and yet permit orthodontics and orthognathic surgical correction as required during subsequent care. The maxillary anterior teeth (Fig 2) were approximately 8.5 mm in length. Utilizing the average length of a central incisor as 10.5 mm to 11 mm allowed an extension of the incisal edges; in this case, to a point where the open bite, from a visual perspective, can almost be closed. The patient’s chief desire was to be able to smile without her tongue showing.

(Fig 3) While the overbite in the finished case would be 0 mm, the overjet would remain at 6 mm, as viewed prior to treatment.

(Fig 5) A putty guide was made over the wax-up and would be utilized intraorally during the placement of the composite restorations.

(Fig 4) A diagnostic wax-up of the maxillary and mandibular arches was created and would be used to guide the build-up of the direct resin restorations.

Treatment Description

The overbite in the finished case was 0 mm, but the overjet remained as it was preoperatively (6 mm) (Fig 3). The diagnostic wax-up was completed (Fig 4) on both the maxillary and mandibular anterior teeth and was used as a guide for the creation of the composite restorations. A Sil-Tech putty guide (Ivoclar Vivdent; Amherst, NY) was made over the wax-up and was utilized intraorally during the placement of the composite restoration (Fig 5). The guide was tried in intraorally prior to placement of the composite restorations to ensure a precise fit. The facial aspect of the guide was cut away with a sharp scalpel to expose the facial surfaces of the teeth. It was important to keep the incisal edge characterized, as composite was placed directly into the guide. In this case, a decision was made to change the shape of the eight maxillary anterior teeth (and possibly the eight mandibular teeth).

One method of testing for shade compatibility is to overlay a thin layer of the various composites being used in the process on the unprepared, unetched tooth and to light-cure it for a few seconds before beginning the procedure. This will provide a fairly accurate determination as to how the final shade will appear.

Dr Rhys Spoor DDS Aesthetic & Restorative Dentistry - Providing services in cosmetic and sleep dentistry to the area of Seattle, Washington.

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