Dr SK Sameer Hussain1
, Dr Vivek Lath2
, Dr Saumya Sharma3
Post-graduate Student
2 Associate Professor, 3 Professor and Head of Department,
Department of Prosthodontics, Crown & Bridge.,
Maitri College Of Dentistry & Research Center, Anjora, Drug. (C.G)
To understand the interaction between different streams of dental restorative treatments it is
essential for the clinicians to practice various challenges to achieve good results. Smile is an
integral part of odontology. Patients come along with the prime aim of achieving esthetics. The
dental practitioner could preserve or alter the relationships of the visible elements of the oral region
to give the required esthetic result.
This case report describes an inter-relation between prosthodontics, endodontics, orthodontics &
periodontology as a part of interdisciplinary dental treatment, because without such approach
treatment outcome may be compromised and can necessitate extensive treatments.
Keywords: Anterior Esthetics, Lithium Disilicate, Crown lengthening.
Citation: Hussain S, Lath V & Sharma S. Interdisciplinary Approach to Recreate Anterior
Esthetics -A Case Report. J Prosthodont Dent Mater 2022:3(1):87-94.
Today’s patients seeking esthetic dental treatment need to reinforce their look for an improved
quality of life and higher self-esteem. The esthetic worth of a cosmetic restoration could also be
compromised by alternative factors contributing to the composition of a delightful smile, like
quantity of gingival show, gingival design, clinical crown dimensions, and tooth position. To
provide the best level of dental treatment varied disciplines of dental medicine ought to be used
along.1 adjunctive treatment involves tooth movement designed to reinforce the success of
alternative dental procedures necessary to revive function. If existing tooth positions make it
impossible or troublesome to insert dental restorations, then treatment ought to become a part of
Hussain SK. et al: Interdisciplinary Approach to Research Anterior Esthetics- A Case Report
The JPDM I Vol 3 I Issue 1 I 2022 87
the treatment plan.2 On the other hand, the inter-relationship between endodontics and
prosthodontics typically resembles interdependence.
Today, each dental practitioner should have a radical understanding of the roles of those varied
disciplines in producing an esthetic makeover, with the foremost conservative and biologically
sound interdisciplinary treatment plan possible.3
Thus, within the present case report we tend to emphasize on the interdisciplinary approach
employing a combination of prosthodontics, periodontology, orthodonture and endodontics to:

  1. Assess and diagnose the case.
  2. Resolve the downside to maximum esthetic results for our patient.
    A 24-year-old male patient reported to the department with a chief complaint of an unaesthetic
    smile due to lost crown structure of upper front teeth. He gave a history of root canal treatment of
    the upper right central incisor, whose crown structure had been lost due to trauma 4 years back.
    He also reported repeated dislodgement of the upper central incisors’ crowns. An oral examination
    of the patient revealed various findings enumerated in the fig. 1
    Fig:1 Intraoral Findings
    After complete evaluation of intraoral status (fig 2 & 3) of patient treatment and radiographic
    diagnosis with the same (fig 4) was started with a periodontal therapy including gingivectomy and
    osseous recontouring of the gingival soft tissue with 11 and 21. It was followed by closure of
    surgical site with sutures and placement of temporary crown prosthesis. (Fig 5,6,7) As intraoral
    examination revealed a crowding in lower anteriors hence an orthodontic treatment was planned
    simultaneously as a part of interdisciplinary approach. Orthodontic bonding was done with lower
    arch teeth. (Fig: 8 & 9)
    Hussain SK. et al: Interdisciplinary Approach to Research Anterior Esthetics- A Case Report
    The JPDM I Vol 3 I Issue 1 I 2022 95
    Fig 2: Preoperative Front Profile Fig 3: Preoperative Lateral Profile
    Fig 4: IOPA With 11
    Fig 5: Gingivectomy Fig 6: Osseous Recontouring Fig 7: Temporary With11,21
    Fig 8: Orthodontic Bonding with Lower
    Fig 9: Aligned Lower Anteriors
    Hussain SK. et al: Interdisciplinary Approach to Research Anterior Esthetics- A Case Report
    The JPDM I Vol 3 I Issue 1 I 2022 90
    Radiographic and intraoral examinations of 11 shown dislodged crown prosthesis which was
    planned for re-RCT and post and core prosthesis further. After completion of endodontic
    treatment, post space was prepared and it was verified by IOPA radiograph. (Fig: 10,11). The
    core was built with tooth coloured composite cement restoration. (Fig:12). Gingival retraction
    was done with 11 and 21 for better record of gingival finish lines, and an impression was made
    with elastomeric impression material (fig:13 & 14).
    The impression was scanned and E-max crown prosthesis was milled and fabricated. Fabricated
    crown prosthesis was then cemented by following the cementation protocol, inner surface of crown
    was conditioned with 10% hydrofluoric acid and the prepared tooth surfaces were acid etched 37%
    phosphoric acid. (Fig:17,18) And crown prosthesis was cemented on 11 and 21.fig 18 and 19
    shows postoperative intraoral front & lateral profile of patient.
    Fig 10: Re RCT With 11 Fig 11: Post Space Preparation With 11
    Fig 12: Composite Restoration Fig 13: Gingival Retraction With 11 & 21
    Hussain SK. et al: Interdisciplinary Approach to Research Anterior Esthetics- A Case Report
    The JPDM I Vol 3 I Issue 1 I 2022 91
    Fig 14: Impression Made with Elastomeric Impression Material
    Fig 15: Fabricated E-Max Crown Prosthesis
    Fig 16: Conditioning of Crown Prosthesis Fig 17: Acid Etching of Tooth Surfaces
    Fig 18: Postoperative Intraoral Front Profile
    Hussain SK. et al: Interdisciplinary Approach to Research Anterior Esthetics- A Case Report
    The JPDM I Vol 3 I Issue 1 I 2022 94
    Fig 19: Postoperative Intraoral Lateral Profile Fig 20: Preoperative Extraoral Profile
    Fig 21: Postoperative Extraoral Profile: Front and Lateral View
    To achieve excellence in restorative dental procedures particularly within the anterior dentition,
    it’s needed that each practitioner and ceramist be intimately familiar with the essential principles
    of natural dental esthetics. to assist the clinicians, offer the most effective esthetic results,
    mathematical theorems like the “golden proportion”4,5 and also the “golden percentage”6 are
    planned. However, Lombardi declared that strict application of the golden proportion proved to be
    too rigid for dentistry. gingival morphology is essential in prosthodontics because it determines
    the outlines and extensions of the dental prosthesis.7 and may contribute considerably to the
    ultimate dental and facial esthetics.8,9
    There are many periodontal procedures that may modify the gingival contour. they can be
    classified into 2 categories: subtractive and additive. Subtractive strategies involve increasing the
    clinical crown length by removing soft tissues, with or without ostial modifications10. These
    procedures are indicated to re-establish a physiological biological width in cases wherever a
    fracture line, perforation or the restorative margin are situated subgingivally. lengthening a short
    clinical crown enhances the retention and resistance forms which will be achieved during a crown
    Hussain SK. et al: Interdisciplinary Approach to Research Anterior Esthetics- A Case Report
    The JPDM I Vol 3 I Issue 1 I 2022 93
    preparation. This is often necessary if the clinical crown height is less than 3 millimetres.11 A
    further advantage of crown-lengthening surgery is the elimination of periodontal pockets.
    aesthetically, subtractive strategies will increase tooth show and resolve uneven gingival contour.
    The gingival apparatus plays a vital role in the overall beauty of an individual’s smile. Esthetic
    periodontal cosmetic surgery is changing into an indivisible part of dental treatment as patients
    become progressively more aware of dental esthetics. Therefore, it’s necessary for clinicians to
    remember the various choices, the reliability of those treatment modalities, the consistency of
    results and also the long-term prognosis. Short crowns and/or excessive gingival display are
    considered as unpleasant by many patients.12
    Tjan et al. described the position of the upper lip line in relation to the teeth and gingiva as an
    important factor in the esthetics of a smile.13 They reported an anterior crown height display of
    less than 75% in a low smile and of 75–100% in an average smile.
    A high or ‘gummy’ smile, on the other hand, shows the full length of the anterior crown heights,
    in addition to a band of gingival tissue. Before the decision is made regarding the type of surgical
    procedure, pre-prosthetic planning of the desired esthetic outcome should be performed. An
    assessment of the smile line and periodontal parameters is paramount in determining the most
    suitable treatment plan and surgical approach to correct the excessive gingival display. The
    surgical management of short crowns by crown lengthening may include gingivectomy or apically
    repositioned flap, with or without ostectomy. Gingivectomy is indicated in type I altered passive
    Orthodontic treatment as an adjunct to prosthodontic and restorative dentistry can significantly
    enhance a favorable result. A healthy periodontium is a prerequisite for success with any dental
    treatment. Without a strong interdisciplinary relationship between periodontics and prosthodontic,
    esthetic, endodontic and orthodontic modalities, the treatment outcome may be compromised. By
    beginning with esthetics, and taking into consideration the impact on function, structure, and
    biology, the clinician can use the various disciplines in dentistry to deliver the highest level of
    dental care to each patient. It really works. We call this process interdisciplinary esthetic dentistry.
    Hussain SK. et al: Interdisciplinary Approach to Research Anterior Esthetics- A Case Report
    The JPDM I Vol 3 I Issue 1 I 2022