Once we have planned incisal edge or gingival position changes there can be a variety of next steps. We may want a way to show the patient the impact of the proposed esthetic changes directly in their mouths. One of the hesitations I experience with my patients when we discuss major esthetic changes is the unknown. I can tell you from personal experience when I was embarking on my own reconstruction, looking at a wax-up, even a perfect one, doesn’t transfer to what this will look like in my mouth. This simple, quick technique is a way to dispel all of the uncertainty and invest the patient in the outcome. Another next step might be the gingival surgery if the patient is ready to go. Whether you are doing the procedure yourself or sending it to a member of your interdisciplinary team, a surgical template is a great communication tool. The snap on trial smile doubles as a surgical template and I use it during the procedure to mark the tissue to remove. Lastly, many of my patients ask to take this simple piece of composite home to show their friends and family members. We simply place it in a retainer case, and off they go.
- Transfer the proposed tooth proportion to an upper model. Use ratios to get the appropriate measurements.
- Draw out the gingival scallop with or without proposed papilla changes.
- Lubricate the model generously with Vaseline.
- Place composite over the anterior teeth on the model.
- Shape and thin the composite to cover the red lines at the gingiva and any incisal edge addition.
- Cut around your proposed gingival lines and create embrasure form with a Hollenbach carver.
- Cure composite.
- Remove from model by pulling up toward the incisal as if removing veneer provisionals.
- Trim like a veneer provisional.
In the next post I will actually use the trial smile for patient communication and as a surgical guide for the gingivectomy.
Joe Bulger says
Excellent lesson. I’ve been doing something similar with wax-up transfers, but that doesn’t address gingival position. Your technique shows the benefits of crown lengthening. I’ve done direct composite mockups for that purpose. But those mockups are thrown away upon removal.
My only concern would be the bulkiness of the snap-on frame in demonstrating changes to the smile. Some people only see what they can see. If shown a bulky smile, they have it stuck in their mind that’s the best you can do for them.
Lee Ann Brady says
Joe, I explain the thickness of the trial smile to all of my patients up front so they know we are not going to be changing the thickness of their teeth or position, or that we are if this is part of the plan. I also let them know that the idea is so they can see the shape changes. What I ask them to do is use a mirror we have int he hall or the patient restroom to look, and try not to give them a hand mirror becasue this is not about details at two inches away. I will also take photos of a lips at rest, full smile etc with the trial smile in and give them with and without photos for comparison.