Using 3D Wax-ups in Gingivectomy Cases

Part 1: Clinical analysis and 3D Aesthetic Guide

Case Report by: 

Dr. Diogo Alves, DDS

Introduction:

Over the years how we use 3D digital wax-ups have evolved – facilitating the dentist’s journey to bringing the final results to the patients.

Facially guided 3D wax-ups and mockup trials should always be included as part of the treatment plan process to ensure the success of the treatment as it combines the practitioner’s clinical analysis while checking on facial proportions and aesthetics. Moreover, it respects the patients’ wishes and improves communication with those involved in the treatment.  

In this multidisciplinary treatment plan, SmileFy 3D Smile Design was used to create 3D wax-ups for the different stages of the case. 

We will go over the gingival guide and studies in this part.

The Case

A 40-year old female patient came in asking for aesthetic improvement to her smile.

An aesthetic analysis showed the necessity to reshape the teeth form, correct uneven gingival margin, and whiten the teeth by changing old composite restorations and replacing them with crowns and veneers. 

Patient requested to keep some of her gingival exposure to maintain the identity of her natural smile. 

After clinical examination and perio analysis, the 3D digital wax-up was initiated.

1- Patient Digitalization

Frontal Facial Smiling Picture  [Figure 1] (Patient’s identity is hidden)

[Figure 2] Upper IO San

[Figure 3] Lower IO San

These required files were uploaded into SmileFy in order to continue the Smile Design process.

2 - 3D Calibration and Digital Wax-up Creation

To create the digital wax-up in SmileFy 3D Smile Design, the intraoral scan and patient frontal picture must first be calibrated as shown in the screens below. [Figures 4 and 5]

[Figure 4]

[Figure 5]

As for the gingivectomy portion of the treatment in the full rehabilitation case, the arch form was set in accordance to the patient’s existing anterior teeth positions to guide the new position of the future 3D teeth. [Figure 6]

[Figure 6]

Using SmileFy’s 3D smile frame, the length and width were determined using a proportion close to 75%.

[Figure 7]

The 3D teeth were then selected for the 3D wax-up [Figure 8] and automatically placed into the 3D smile frame following the proportions predefined in the previous screen [Figure 9].

[Figure 8]

[Figure 9]

A variety of different 3D teeth templates are available to choose from with natural tooth morphology. This allows the smile designer to easily create multiple variations of the wax-up for the patient. A facial analysis was checked again to follow the facially guided approach. [Figure 10]

[Figure 10]

To determine the proper smile zenith curve, the central incisors should preferably be 0.5 to 1.0mm lower than the canines and the lateral incisors 0.5 to 1 mm lower than the central incisors. The 3D wax-up length of the teeth was adjusted over the gum line to fulfill proper balance and harmony and measured in the SmileFy software. [Figure 11]

[Figure 11]

Before exporting the 3D wax-up, final adjustments were made in the mesh editor of the application to define proper teeth contour over margins, embrasures, papilla, and to determine the thickness of the design.

[Figure 12]

[Figure 13]

3 - .STL export and 3D Printing

The 3D digital wax-up was then exported as an .STL file and printed in-office using Sprint Ray’s Pro 95 3D Printer.

4 - Mock-up try-in, and patient’s evaluation

In short, the 3D wax-up is to be considered essential in cosmetic and restorative treatments for four main purposes:

1- so the patient can better understand the expected final outcome 

2- allows for a fast and efficient in-office workflow 

2- provides a guide for esthetic/functional procedures 

4 – enables more control over the treatment plan

The advantages of creating facially guided 3D wax-ups are not only related to the aesthetic validation but also help practitioners access more predictable treatment plans and more assertive communication.

Case Report Review:

Using 3D Wax-ups in Gingivectomy Cases [Part 1]

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