The aesthetic characteristics of the patient were assessed from three
macro-, mini-, and micro-aesthetic views, and the following problems
were reported for the patients:
- From a macro-aesthetic view: asymmetrical eyes (the
inter-pupillary line was not parallel with the horizon plan).
- From a mini-aesthetic view: the incisal plane was not
parallel with the horizon; the smile arch did not coincide with the
lower lip; the presence of occlusal plane canting; more gingiva was
shown at the right side; midline deviation; asymmetrical smile; the
RED proportion was not respected.
- From a micro-aesthetic view: discoloration of teeth;
anatomical proportions were not respected; asymmetry in gingival
height and zenith; the problems with crowding and the longitudinal
axis of teeth.
The treatment plan
selection
The examinations suggested that the lack of stable contacts in palatal
segments of the upper anterior teeth caused the dental cingulum loss in
the upper jaw dentition. This alteration led to overgrowth of upper and
lower teeth and ultimately aggravated the deep bite. During the
examination of the casts, the CR contact of the lower anterior teeth on
palatal tissues was observed.
The aesthetic treatment plan will be preceded by creating a stable
posterior and anterior occlusion. The first stage of treatment consisted
of establishing stable contacts by cingulum restoration for upper
anterior teeth while creating smooth edges for the lower anterior teeth
to ensure stable contacts of lower anterior teeth on palatal surfaces of
the upper anterior teeth. Thus, after the clinical examination of the
patient and analysis of the study casts, the Dahl technique was decided
to be used for restoring and establishing occlusal contacts in correct
positions to modify the occlusion and open the bite (figure 5).