Deborah visited the clinic after her jacket’s zipper cracked the porcelain veneer on her upper left front tooth, causing the cracked portion of the veneer to fall off. It was temporarily repaired with composite—a tooth-colored, filling material—which made her front tooth appear elongated, due to recession of her gum tissue. It was noted that many of her teeth had notches in the root surface, called “abfractions,” consistent with clenching and grinding, which had resulted in asymmetry of her gum tissue and an uneven smile line.

In discussing the case with the aesthetic technicians at the dental laboratory, it was decided that it would be more beneficial to cover the abfractions with porcelain veneers across all of her anterior teeth, as opposed to replacing only the veneers on her central incisors. This quickly became a complicated, multidisciplinary case that took several months. In order to achieve optimum aesthetics, Deborah was referred to a periodontal specialist for a connective tissue graft to repair her receding gum tissue. Once the graft had healed, the periodontal specialist performed gingival recontouring to provide a symmetrical smile line for Deborah. Her teeth were then bleached to her desired shade, so an exact color match could be obtained to fabricate the veneers.

Deborah’s case was further complicated by the previous death of the pulp in one of her central incisors, which had darkened the tooth. The doctor, the laboratory technician, and Deborah discussed the options of using feldspathic porcelain versus pressed glass to address the discolored tooth, while still providing both optimum strength and aesthetics. Great care needed to be taken to avoid violating the connective tissue graft during veneer preparation to prevent further receding of the gum tissue. Finally, Deborah was provided an orthotic splint to protect the veneers and address her bruxism (clenching and grinding) habit. Both Deborah and Dr. Glavan were ecstatic with the overall aesthetic result!