Hi everyone and Happy new Year. This is an interesting case I would like to share and get some feedback on if possible. To try and condense the details of the case this patient wanted to have her teeth straighter and whiter and dislikes the bulky appearance of the #8 crown.She is 52 years old. She has had orthodontics done twice;once as a child and then in 2001.

She has had an orthodontic consultation.The orthodontist is gong to intrude #20 #21 #22 with TADS and then extrude #9 through #13 to correct the cant. She will have the diastema closed on the lower teeth and they will be aligned to try and gain contact with the maxillary anteriors. #8 and #10 existing ceramic crowns will be removed and replaced with temporary crowns as they have bulky cingulum contours and #8 is the only contact with MIP with #25. The orthodontist recommended crown lengthening on #7 #8 #10, prior ot orthodontics to make it easier to level everything during the extrusion. I spent some time looking at the tooth position and the tooth proportion on the diagnostic casts.
#8 measures about 8.5mms in width and 9mms in length.
#9 measures 8mms in width and about 10 to 10.5mmms in length but there is gingival recession (about 1mm) and it is about 0.5mms shorter than the incisal edge of #8.The pocket depths are 2 to 3mms all round except for #5 where there isolated 5 and 6mm pockets.
It would be ideal to have #8 with the same width as #9 .If the width of #8 was reduced to 8mms and if it was crown lengthened by 1mm to 10mms the proportions would be ideal.
If the recession defect is grafted #9 (at the advice of the periodontist) prior to extrusion and the tooth is extruded to align it with the incisal edge of #8 then it will have ideal proportions (10mm by 8mms) Prior to orthodontics we will remove the ceramic crowns on #8 and #10 and place temporary crowns. I could make a temporary crown #8 8mms in width and there would be a small diastema 0.5mms at #8 and #9 which I could ask the orthodontist to close.
It seems by looking at the tooth position of #8 and 10, the thicker rolled gingiva, and the thick lingual cingulum on the crowns ,that #8 and #10 roots are maybe lingually positioned in the arch? If the roots were torqued facially this might address the appearance of shorter gingival zeniths on #8 and #10 and the crown lengthening may be minimized?Torquing the roots buccally might close a 0.5mm diastema if we narrowed #8?
If she does need the crown lengthening then #7 would only need maybe 0.5mms as the proportions of this tooth are quite good. It is about 8mms length by 6.5mms wide.Once the defect of #9 recession is grafted I do not think crown lengthening #10 will be necessary as the zenith will not appear so short compared to #9?
Shall I have the periodontist do the graft on #9 before the existing crowns #8 and #10 are removed prior to ortho? I can get a diagnostic wax up of #7 #8 #9 #10 so we can see how to idealize the tooth proportions with tooth movement and anticipated crown lengthening? The final treatment plan I suggested would be to have crowns replaced #5,8,10,13, veneers #6,7,9,11 12(onlay veneer) and an implant crown #4 (with particulate grafting) to have a shortened dental arch. She is was interested in replacing her attachment retained partials that have worn teeth, with implants.She would need extensive grafting for molar implants.Otherwise we would make her new partials with attachments and have her wear an occlusal guard to protect the ceramics. #5 has a grade 1 mobility and has had RCT with a post so I am thinking if she were to have another partial with an attachments we would splint the crown #5 with a crown on #6.
Thank you very much for taking a look.
Best wishes,
Sharon