Title: Retreatment of Anterior Esthetic Prosthetics Considering Both Esthetics and Function
Summary: Anterior crown retreatment case focusing on both esthetics and function. A female patient in her 60s visited from Germany to replace 20-year-old anterior dental crowns. Due to gingival recession, exposed root surfaces, and progressive wear, comprehensive evaluation and retreatment were required. Using 3D intraoral scanning, digital smile design, and diagnostic wax-up, we carefully redesigned the anterior restorations. Provisional crowns were placed to evaluate pronunciation, bite (occlusion), smile line, and esthetic harmony before fabricating the final prostheses.
This case demonstrates that anterior crown replacement is not just cosmetic dentistry, but a multidisciplinary treatment involving periodontal condition, tooth wear, occlusion, phonetics, and facial balance.
Hello! This is Yonsei JW Dental Clinic in Gangnam-gu, Seoul, Korea. Today, we would like to talk about the case of a female patient in her 60s who visited us from Germany, wishing to replace her anterior prosthetics that had been done about 20 years ago.
The existing prostheses themselves were relatively acceptable; however, over a long period of time, the gums had gradually receded, exposing the tooth roots. Wear had progressed on the exposed root surfaces, and not only from an esthetic standpoint but also in terms of dental health, crown retreatment appeared to be necessary.
In this treatment, prostheses covering a wider tooth surface area than before were required. In particular, wear was observed on the inner surface of the maxillary central incisor crown, making it possible that additional tooth reduction would be unavoidable after crown removal. Accordingly, we thoroughly explained the possibility of root canal treatment in advance before beginning the procedure. In addition, when removing such old prostheses, it is common to discover secondary caries inside; therefore, we also informed the patient beforehand about the possibility of additional resin treatment.
In cases where multiple anterior crowns need to be replaced, it is extremely important not only to explain the current condition but also to have sufficient communication and consultation with the patient regarding the design of the final prostheses. In this patient’s case, she felt that her existing anterior teeth were overall too large and gave a“masculine” impression. She also wished to replace them with a brighter shade.
According to the smile line analysis, compared to her actual smile, the anterior tooth line appeared somewhat flat.
In the 45-degree and 90-degree lateral photographs as well, the anterior tooth surfaces were generally flat, and much of the anatomical form of the teeth had been lost. Despite being prosthetic restorations, they gave a somewhat aged impression. For international patients seeking esthetic dentistry in Korea, comprehensive smile analysis and digital planning are essential to achieving natural and harmonious results.
For a more precise consultation, we performed a 3D intraoral scan prior to treatment. After designing the final prosthetic form as a digital wax-up, we fabricated a 3D-printed model and conducted a second consultation with the patient. As she was initially satisfied with the design, we removed the existing prostheses on the same day and provided provisional restorations of the same design.
During this process, the left premolar—where gingival recession and periodontitis had progressed-developed severe sensitivity as anticipated. Therefore, in accordance with the prior explanation, additional root canal treatment was performed. Furthermore, to improve the smile line, and with the patient’s consent, we reduced the extruded mandibular anterior teeth by approximately 1 mm to achieve overall harmony. Although there were limitations in reducing the absolute size of the teeth, we adjusted the tooth form as much as possible to create a softer and more “feminine” visual impression, giving the illusion of a narrower appearance.
Extensive anterior prosthetic treatment can affect the patient’s pronunciation and eating. To evaluate and modify this, the patient was asked to use the provisional restorations for several days. She reported some difficulty with pronunciation, so we reflected this feedback during the provisional stage and made adjustments. We also incorporated her request to slightly shorten the length of the anterior teeth. Patients considering anterior crown replacement in Korea often ask whether pronunciation or eating will be affected. This provisional phase allows us to verify and refine both function and esthetics before final fabrication.
When sufficient design adjustments and consultations are completed during the provisional stage, a more precise design can be delivered to the dental laboratory, significantly increasing satisfaction with the final prostheses. This case highlights how digital smile design and 3D intraoral scanning significantly improve the accuracy and predictability of crown retreatment, especially in complex anterior cases. Since the anterior restorations are visible when smiling or speaking, and as the mandibular anterior teeth are also planned for future prosthetic treatment, the shade wasfabricated to the brightness level desired by the patient rather than matching other existing restorations.
Anterior prosthetic treatment is not simply about making new crowns; it is a comprehensive treatment that must consider the condition of the gums, tooth wear and position, smile line, pronunciation, and mastication. Especially when replacing old prostheses, previously hidden issues are often discovered. Therefore, step-by step planning and a verification process through provisional restorations are critical factors that determine the accuracy and stability of the final treatment outcome. Through this approach, it is possible to achieve results that satisfy both esthetics and function, while significantly improving long-term maintenance and patient satisfaction.
In this case, because we thoroughly communicated with the patient and adjusted the design during the provisional stage, we were able to proceed in a direction that satisfied both functional and esthetic goals. In particular, the anterior teeth are almost always visible when smiling or speaking, so even slight discrepancies in shape or color can greatly alter one’s impression. For this reason, we carried out meticulous design adjustments and step-by-step verification through sufficient communication with the patient in order to create prostheses that harmonize with the entire face and smile.
"At Yonsei JW Dental Clinic, Dr. Jiho Ahn, a board-certified prosthodontist and an adjunct clinical professor at Seoul National University School of Dentistry, provides highly refined dental care based on extensive clinical experience. All treatments are carried out strictly in accordance with evidence-based dentistry."
For patients residing overseas, we offer pre-treatment consultations via WhatsApp.
If you send us your panoramic Xray, we can also provide a more detailed discussion of your treatment plan. During the consultation, we thoroughly explain available treatment options-including crowns, single implants, bridges, and full-arch implant solutions-as well as suitable implant brands and systems, such as Osstem and Straumann, and their respective grades.
Unlike some Gangnam clinics where consultations with the dentist last only a few minutes and patients end up discussing treatment mainly with a coordinator, you can feel assured that you will receive thorough, direct consultation with the doctor and comfortably ask all your questions.
Many of those considering implants may have already gathered a lot of information by searching for “Gangnam implant nearby dental clinic.” Even so, receiving a detailed explanation through an in-person consultation with a specialist can be of great help in making your decision.
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