Smile Design Cases
Transform a Smile with Advanced Cosmetic Dentistry: Precision, Aesthetics, and Long-Lasting Results
Case 71
Cosmetic Dentistry in Toronto
Before Smile Transformation
A 73-year-old patient arrived at Dr. Johnson Ozgur’s Toronto Smile Design - Yorkville Dental office, seeking help for severe dental issues that had progressively worsened over the years. The patient’s teeth were profoundly worn, eroded, and stained yellow, leaving the entire dentition devoid of functional elements such as cusps, anterior guidance, or canine guidance. This extensive deterioration compromised his ability to chew and speak and adequately impacted his confidence and social interactions. The patient described struggling to eat various foods, frequently experiencing discomfort while speaking and avoiding social situations due to embarrassment over his smile. His dental health issues required an advanced and comprehensive approach to restore both function and aesthetics.
Digital Smile Design Planning of the Smile Transformation
Worn Out Teeth = Collapsed Bite
The patient’s excessively worn-out teeth had led to a significant collapse in the vertical dimension of occlusion (VDO), a critical factor in maintaining facial harmony and functional stability. As the teeth eroded over time, the reduced VDO caused the lower jaw to move closer to the upper jaw, altering the patient’s facial proportions and giving him a prematurely aged appearance. This collapse also affected the soft tissues around the mouth, resulting in decreased lip support. The lack of adequate dental structure to support the lips led to a hollow facial profile, accentuating wrinkles around the mouth and creating an overall appearance of fatigue and advanced aging. Functionally, the compromised VDO disrupted the balance and alignment of the jaw, contributing to difficulties in chewing and phonation. The combination of these factors highlighted the urgency of addressing the aesthetic concerns and restoring the dental framework's structural integrity to rejuvenate the patient’s appearance and improve his oral function.
Intraoral Picture of the patient before Smile Makeover
4D Dentistry: Crucial Step for Functional Treatments
Before proceeding with Digital Smile Design (DSD) documentation, Dr. Johnson utilized the MODJAW device to record the patient’s dynamic jaw movements, a step of paramount importance in a case of this complexity. MODJAW, the first of its kind in Ontario, enables precise, real-time tracking of jaw function, capturing the intricacies of the patient’s articulation and occlusion. For this patient, whose collapsed vertical dimension and lack of anterior or canine guidance had destabilized his bite, understanding the jaw’s functional patterns was crucial to designing a treatment plan that would restore balance and harmony. By analyzing the dynamic relationship between the jaws, Dr. Johnson could identify aberrant movements, pinpoint functional deficiencies, and predict the biomechanical impact of the proposed restorations. This comprehensive data allowed for a tailored approach to rebuilding the patient’s occlusion, ensuring that the new restorations would fit aesthetically and function seamlessly within his unique jaw mechanics. Accurate jaw movement records are the foundation of any full-mouth rehabilitation, as they enable a design that promotes long-term stability, minimizes strain on the temporomandibular joint (TMJ), and enhances the overall success of the treatment.
Crucial Step: Creating a Digital Patient
At Toronto Smile Design - Yorkville Dental, no treatment plan is ever proposed without a meticulous design and 3D simulation to ensure predictability and precision. For this 73-year-old patient, after obtaining dynamic jaw movement data with MODJAW, we proceeded with a comprehensive set of documentation, including intraoral and extraoral photographs, high-resolution portrait images, videos, and facial scans using the Ray Face scanner. Each piece of information plays a critical role in building a holistic understanding of the patient’s current condition. Intraoral photographs and scans reveal the state of the teeth and soft tissues, while portrait images and videos capture how the patient’s smile interacts with their facial expressions and features, ensuring that the final design harmonizes with their overall appearance. Facial scans provide a digital framework for integrating the planned restorations seamlessly into the patient’s natural anatomy.
The Necessity of Advanced Dental Imaging: Full Skull CBCT
To complement this data, we requested a full skull CBCT scan, a cornerstone of sophisticated treatment planning for complex cases. The CBCT allows us to visualize the patient’s craniofacial structure in three dimensions, providing unparalleled detail of the teeth, bone, sinuses, and surrounding anatomical structures. In this case, segmentation of the skull and mandible enabled us to analyze the temporomandibular joint (TMJ) in motion, offering critical insights into how the jaw moves during various functional activities. This level of visualization ensures that we can identify any underlying joint issues, assess the impact of the collapsed vertical dimension on the TMJ, and design restorations that restore functional equilibrium. Without these advanced diagnostic tools, it would be impossible to create a treatment plan that ensures both functional integrity and aesthetic excellence, making this step an indispensable part of the smile design process.
Preparing for the Mock Up & Increasing the VDO
For a case as complex as this patient’s, creating a new occlusal surface to open the vertical dimension of occlusion (VDO) is a non-negotiable foundation for successful treatment. The patient’s collapsed VDO not only compromised his facial aesthetics but also disrupted his bite dynamics and functional stability. Re-establishing a proper VDO allows us to rebuild the smile curve in the anterior region, which is critical for achieving a natural and harmonious appearance. The anterior smile curve, defined by the contour of the upper front teeth in relation to the lower lip, is a key element in creating a youthful and balanced smile. Without addressing the underlying occlusal framework, even the most cosmetically appealing restorations would fail to function correctly and could lead to further complications.
Focusing solely on the visible front teeth for cosmetic enhancement would be a superficial and short-sighted approach. While this might temporarily improve the smile’s appearance, it would not resolve the fundamental structural issues caused by the eroded posterior teeth and collapsed VDO. Neglecting the posterior occlusion would likely result in an unstable bite, excessive strain on the temporomandibular joints (TMJ), and the potential for premature failure of the restorations. By contrast, designing and restoring the entire occlusal surface provides the functional support needed to stabilize the bite, distribute chewing forces evenly, and create a robust foundation for the anterior aesthetic work. This comprehensive approach ensures the treatment's longevity and success, delivering a beautiful smile and a fully restored quality of life.
Mock Up: The Test Drive of a New Sew smile
Providing a mock-up is an essential step in the treatment process for a complex case like this 73-year-old patient. A mock-up serves as a tangible preview of the proposed restorations, allowing the patient to visualize and experience the functional and aesthetic outcomes before committing to the final treatment. For this patient, whose teeth were extensively worn and whose VDO required significant adjustment, the mock-up played a critical role in demonstrating how the new occlusal surfaces and smile curve would transform his facial appearance and restore his oral function.
The advantages of the mock-up are manifold. First, it provides the patient with a sense of reassurance and confidence, helping them understand the scope of the changes and how the restorations will improve their quality of life. By wearing the mock-up, the patient can physically experience the impact of the increased VDO, improved lip support, and enhanced smile curve on their speech and chewing abilities. Functionally, the mock-up allows the dentist to test the dynamics of the new occlusion in real-time, ensuring that the design integrates seamlessly with the patient’s jaw movements and TMJ health. Additionally, the mock-up acts as a communication tool, enabling the patient to provide feedback on the proposed restorations' shape, size, or aesthetic details. This collaborative process ensures the final outcome aligns perfectly with the patient’s expectations and needs. Without a mock-up, the treatment process would lack the precision and predictability necessary for a case of this complexity, underscoring its critical importance in full-mouth rehabilitation.
Temporization: Long Term Test Drive
Given the patient’s advanced age and the inherent complexity of his case, providing a long-term temporary restoration was a strategic and invaluable step in the treatment process. This interim phase served multiple purposes, each critical to ensuring the success of the final restorations. Firstly, it acted as a trial period for the patient, allowing him to adapt to the restored vertical dimension of occlusion (VDO), enhanced smile curve, and newly established occlusal surfaces. By living with temporary restorations, the patient could experience the functional and aesthetic changes firsthand, offering valuable insights into their comfort, usability, and overall satisfaction.
Secondly, the temporary restorations provided a dynamic platform to test and refine the functional aspects of the treatment. Dr. Johnson could use the MODJAW device during this period to record the patient’s jaw movements under real-life conditions, gaining precise data to optimize the final design. This step was crucial when TMJ health and bite stability were at significant risk due to years of erosion and collapse. The temporaries allowed the team to identify and address any issues in occlusal balance, ensuring that the final restorations would be biomechanically sound and long-lasting.
Lastly, the long-term temporaries allowed a detailed assessment of their impact on the patient’s lip support and facial aesthetics. By observing how the new teeth supported the soft tissues and restored harmony to the patient’s facial profile, adjustments could be made to perfect the design before transitioning to permanent restorations. This methodical approach reduced the likelihood of post-treatment revisions and ensured that the patient achieved a functional bite and a rejuvenated and natural appearance. The use of long-term temporaries exemplified the meticulous planning and patient-centric philosophy that defines Toronto Smile Design - Yorkville Dental’s approach to transformative dental care.
Before
After
Complete MODJAW Dynamic Documentation
The MODJAW device captures highly detailed and dynamic jaw movements, providing a comprehensive understanding of the patient’s functional patterns. For a case as complex as this 73-year-old patient’s, obtaining precise data on the following jaw motions was critical to achieving a flawless final result:
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Open and Close Motion: This fundamental movement is essential for understanding how the jaw aligns vertically and whether the teeth make proper contact during closure. For a patient with collapsed vertical dimension of occlusion (VDO), analyzing the open-close trajectory allowed Dr. Johnson to design restorations that reestablish the correct jaw positioning, ensuring comfort and stability during routine activities such as chewing and speaking.
2. Right and Left Lateral Movements: These side-to-side motions are key to assessing the occlusion balance and the canine guidance's functionality. In this patient's case, the absence of canine guidance made this motion particularly important. The data helped design restorations that restored lateral stability, preventing excessive stress on the temporomandibular joints (TMJ) and ensuring smooth, controlled movement during lateral excursions.
3. Protrusion: Forward movement of the jaw is crucial for evaluating anterior guidance, which was missing in the patient due to severe wear. Protrusion analysis allowed for the precise design of anterior teeth that would guide the jaw forward without creating undue stress or interference, contributing to both functional efficiency and aesthetic appeal.
4. Speech Motion: By recording the jaw’s motion during speech, MODJAW provided insights into how the teeth interacted dynamically with the soft tissues and phonetic patterns. This was vital for ensuring that the restorations did not impair the patient’s ability to articulate sounds clearly and naturally, addressing one of his primary complaints about social embarrassment.
5. Chewing Motion: Chewing involves a complex interplay of vertical, lateral, and rotational jaw movements. By analyzing the patient’s natural chewing patterns, MODJAW allowed the restorations to be fine-tuned for optimal functionality, ensuring that the bite could handle various types of food efficiently without discomfort or uneven wear.
These motions collectively painted a detailed picture of the patient’s functional dynamics, enabling the creation of restorations that integrated seamlessly with his unique jaw mechanics. Without this level of precision, the final result would risk being functionally flawed, leading to issues such as uneven wear, joint pain, or dissatisfaction with aesthetics. MODJAW’s advanced motion capture ensured that every aspect of the patient’s treatment was guided by real-time, patient-specific data, setting the stage for long-term success.
Fully Digital Workflow
A fully digital dentistry workflow, supported by the advanced capabilities of MODJAW’s digital TMJ motion tracking, offers unparalleled precision and flexibility, eliminating the limitations of traditional articulators. For this patient, whose case demanded an intricate balance of aesthetics and functionality, staying within a digital workflow from start to finish provided several critical advantages.
First and foremost, the digital workflow seamlessly integrates real-time TMJ motion data captured by MODJAW, ensuring that every adjustment to the design is grounded in the patient’s unique jaw dynamics. While effective to a degree, traditional articulators rely on static, generalized models of movement, which cannot replicate the full range of dynamic jaw functions such as speech, chewing, and lateral movements. Simulating the patient’s actual TMJ behaviour in a virtual environment allowed Dr. Johnson to test and refine the design iteratively, ensuring that the final restorations would function harmoniously within the patient’s specific biomechanical parameters.
The digital platform also facilitated a higher level of customization, especially when modifying the length and angulation of the anterior teeth to enhance the aesthetics beyond what was achieved with the temporary restorations. By adjusting the digital design, Dr. Johnson could fine-tune the smile curve and facial integration with precision, considering factors like lip support, incisal display during speech and smiling, and overall symmetry. These adjustments were guided by continuous feedback from the patient’s functional data, ensuring that the changes improved the smile’s appearance and maintained optimal occlusal balance and jaw function.
Moreover, the digital workflow streamlined the production of the final restorations, reducing the potential for errors and inconsistencies that can arise when transitioning between digital and analog processes. Advanced CAD/CAM technology allowed the finalized design to be fabricated extremely accurately, ensuring a perfect fit and natural aesthetics. This efficiency minimized the need for post-fabrication adjustments, saving the patient and dental team time.
A key partner in achieving these exceptional results was RDT Dental Lab, whose digital design expertise was pivotal in turning intricate designs into precise, high-quality restorations. Their collaboration ensured that every detail of the digital workflow was executed flawlessly, from the initial design adjustments to the fabrication of the final restorations. We sincerely appreciate their dedication and craftsmanship, which were instrumental in delivering a result that exceeded the patient’s expectations. In this case, the decision to remain entirely within a digital workflow, supported by MODJAW’s detailed TMJ motion data and RDT Dental Lab's outstanding work, exemplified dentistry's future, where cutting-edge technology and expert collaboration come together to achieve truly transformative outcomes.
Before
After
SOUND ON!
The transformation for this 73-year-old patient was nothing short of remarkable. Through the meticulous planning and execution of a fully digital workflow, guided by advanced technologies such as MODJAW and comprehensive facial scanning, Dr. Johnson and his team at Toronto Smile Design - Yorkville Dental restored the patient’s smile and his confidence and quality of life. Integrating dynamic jaw motion data allowed for the precise design of functional and aesthetic restorations, while adjustments to the anterior teeth’s length and angulation created a harmonious, youthful smile. The patient now looks rejuvenated, with restored facial proportions, proper lip support, and a smile that radiates health and vitality. He expressed immense gratitude and joy, sharing how the treatment has profoundly improved his ability to eat, speak, and interact socially without hesitation. This case exemplifies the transformative power of modern digital dentistry when combined with expertise and a patient-centred approach, reaffirming the commitment of Toronto Smile Design - Yorkville Dental to delivering life-changing results.
“In an era of rapid change, standing still is the most dangerous course of action.”
— Brian Tracy
Comprehensive Smile Transformation: Full-Mouth Rehabilitation with Digital Dentistry at Toronto Smile Design—Yorkville Dental
At Toronto Smile Design—Yorkville Dental, every smile is a unique masterpiece crafted with cutting-edge technology and artistic precision. Dr. Johnson Ozgur’s expertise in cosmetic and restorative dentistry transforms not just smiles but lives, combining advanced techniques with a patient-centered approach to deliver stunning and functional results.
A recent case exemplifies our dedication to excellence. A 73-year-old patient came to us with severely worn, stained, and eroded teeth, suffering from a collapsed vertical dimension of occlusion (VDO), diminished lip support, and difficulty eating, speaking, and socializing. His case required a comprehensive and innovative approach, leveraging the latest in digital dentistry to restore both function and aesthetics.
The journey began with an in-depth consultation and documentation using state-of-the-art tools like the MODJAW for real-time jaw motion analysis, the Ray Face facial scanner for seamless smile integration, and a full-skull CBCT to evaluate his TMJ movements and bone structure in exquisite detail. This digital-first approach enabled us to design a new occlusal surface to rebuild his VDO and create a balanced, youthful smile curve.
To ensure the best outcome, the patient was provided with long-term temporary restorations, which acted as a trial phase to test function, comfort, and aesthetics. During this period, we refined the smile design, optimized the anterior teeth’s length and angulation, and used MODJAW’s dynamic data to ensure the restorations worked harmoniously with his TMJ and natural jaw movements.
The final phase was a collaboration with RDT Dental Lab, where the patient’s permanent restorations were crafted with unmatched precision. Each porcelain crown and veneer was designed to fit perfectly, restore proper function, and enhance the patient’s facial aesthetics. The result was a rejuvenated, natural-looking smile that restored the patient’s confidence and transformed his overall appearance.
At Toronto Smile Design—Yorkville Dental, we are committed to blending the art and science of dentistry to create results that are as functional as they are beautiful. Whether you require a full-mouth rehabilitation or a cosmetic enhancement, our team will tailor a solution to your needs, guided by advanced technology and a passion for excellence. Contact us today to begin your journey to a life-changing smile!
