Akademik Veri Yönetim Sistemi
The 48. Annual EPA Congress | The 27. Scientific TPID Congress, Nevşehir, Türkiye, 11 - 13 Eylül 2025, (Yayınlanmadı)
Naz Dogan¹, Ayca Muhterem², Akin Coskun³
¹Department of Prosthodontics, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey
²Department of Periodontology, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey
³Department of Prosthodontics, Faculty of Dentistry, Dokuz Eylul University, Izmir, Turkey
A 42-year-old systemically healthy female patient presented with multiple missing posterior teeth. The initial treatment plan involved regional fixed prosthetic rehabilitation. However, after cusp fractures occurred on teeth 24 and 25, the plan was changed to include the maxillary anterior teeth in order to improve esthetics and smile harmony. To achieve proper anterior guidance and an ideal overjet–overbite relationship, the mandibular anterior teeth were also added to the treatment plan, resulting in a full-mouth rehabilitation. The fracture pattern did not suggest any parafunctional habits, and the temporomandibular joint exam showed no signs of dysfunction.
To restore function and reduce the gummy smile, a gradual increase in vertical dimension was planned. The treatment included gingivoplasty from canine to canine in both arches. Endodontic treatment was performed on the maxillary central incisors and laterals (which showed microdontia) to allow for proper prosthetic restoration.
Digital smile design and wax-up guided by facial reference points were used to determine the incisal edge position and smile line. A diagnostic mock-up was tried in both static and dynamic conditions and adjusted to improve esthetics and function. Although the mock-up was basic—especially in the cervical areas of anterior teeth—it served as a useful visual reference and helped motivate the patient.
The patient wore temporary restorations during the adaptation period at the new vertical dimension. PMMA was chosen for these provisionals because of its better strength and durability under chewing forces compared to 3D-printed resin options.
Over eight weeks, the vertical dimension was gradually increased using a blueprint occlusal appliance. During this period, both esthetics and phonetics were reviewed and refined. The patient reported no joint-related discomfort or complications.
Final restorations were delivered using monolithic full-arch prostheses. The result was stable, both functionally and esthetically. This case shows the value of a flexible, multidisciplinary approach supported by digital tools. By combining esthetic planning, vertical dimension control, and digital workflows, a predictable and satisfying result was achieved.
This case demonstrates that early adaptation, trial phases, and clear planning can lead to success in complex rehabilitations. Step-by-step diagnostics—including mock-ups, provisionals, and occlusal splints—gave helpful feedback throughout the process. The patient-centered and evidence-based approach met both esthetic and functional goals, resulting in high patient satisfaction.
Digital smile design, vertical dimension, gummy smile, deep bite, full-mouth rehabilitation