Clinical Background : This patient was a highly self-conscious and emotionally distressed patient, presented with a severely compromised smile she had struggled with for years. She had previously undergone various restorative procedures, including crowns and veneers, but remained unsatisfied with both the aesthetics and function of her dentition. Clinically, she displayed a severe gummy smile, an imbalanced occlusal relationship, and significant skeletal discrepancies. The upper anterior teeth appeared disproportionately small within the facial frame, and her occlusion was characterised by a Class II division 1 pattern with excessive overjet, traumatic bite, and vertical disharmony.
This case resulted in a dramatic transformation both functionally and emotionally. Our patient regained a confident smile, improved occlusal stability, and a harmonious facial profile. The prosthetic plan—removable in the upper arch and fixed in the lower—balanced patient comfort, hygiene access, and long-term function.
Her previously “gummy” smile was corrected through a combination of skeletal and prosthetic modification, resulting in a natural, proportionate smile line.
The case highlights how careful skeletal planning, vertical correction, and prosthetically guided implant placement can be leveraged to rehabilitate patients with severe dentofacial compromise. Paulette’s outcome stands as a testament to interdisciplinary planning and patient-centred care.
Diagnosis and Treatment Plan
A dual-arch rehabilitation was indicated, combining surgical intervention, vertical dimension correction, and prosthetic reconstruction to address Paulette’s functional and aesthetic needs.
Maxillary Arch
Mandibular Arch
The lower jaw showed significant resorption, a failing occlusion, and limited restorative space. A fixed solution was preferred given the patient’s functional goals and dislike of removable prostheses in the mandible.
This case demonstrates the profound impact that integrated surgical-prosthetic planning can have on both the functional and emotional wellbeing of a patient. Paulette’s rehabilitation addressed not only the biomechanical challenges of occlusal instability and skeletal discrepancy, but also the psychosocial distress associated with her smile aesthetics.
The decision to use a removable maxillary prosthesis alongside a fixed mandibular FP3 restoration was a deliberate one—balancing prosthetic feasibility with patient preference and long-term maintenance. While lower dentures are often poorly tolerated due to tongue interference and instability, fixed solutions can significantly improve comfort and function. Conversely, the maxilla allowed for a well-retained denture with excellent aesthetic control, especially following alveolar reduction.
Importantly, this case illustrates the value of vertical dimension correction and alveolar osteoplasty in reshaping the prosthetic envelope and repositioning the smile line. By controlling these parameters surgically and prosthetically, we were able to eliminate the excessive gingival display and restore a natural, proportional smile.
Ultimately, Paulette’s case highlights the importance of patient-centred treatment planning and interdisciplinary collaboration. A prosthetically driven approach, combined with soft and hard tissue surgery, allowed us to transform a high-anxiety, high-complexity presentation into a predictable, functional, and aesthetic outcome.
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Trust Dr. Arman Barfeie to transform your smile with expert dental implants, stunning cosmetic treatments, and thorough, personalized care. Enjoy a warm, patient-focused experience that guarantees your comfort and delight at his premier Forest Hill dental practice.