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.