An initial consultation was scheduled to allow the patient and me to meet and to discuss her desired outcome. The patient shared that she had made the decision to have her upper front teeth veneered to improve the aesthetics of her smile. Her job required her to meet with many top executives, and she wanted to feel confident about her appearance. Since making that decision, she had been on a roller coaster, as the restorative treatment resulted in the loss of the upper left central. The patient had gone through several removable tooth replacements over the months of attempting to have a fixture placed and successfully integrate. The idea of more surgery was not a negative for her, but the alternative idea of continuing to use a removable device or to have a bridge done seemed worse, so she was determined to forge ahead with getting an implant. It was very important to her to understand why the original implant fixtures had not worked, what the treatment plan was, and how confident we were about achieving success this time. After this initial discussion, an appointment was scheduled to complete a comprehensive evaluation so we could gather the information and data to answer her questions and to formulate possible treatment plans (Figure 1).

Comprehensive Examination
The patient had no history of joint or muscle issues or headaches. The joint exam revealed no palpable joint sounds and no history of locking open or closed. Examination of the muscles revealed some minor tenderness to palpation in the medial pterygoid region. Her range of motion measurements were within normal limits. She reported no history of jaw fatigue when eating or during dental visits. She exhibited very little to no evidence of occlusal disease with minimal to no tooth wear; the patient still had mammelons on most of her mandibular incisors. She had a small slide from centric occlusion (CO) to maximum intercuspation (MIC) of 1.0 mm anterior and 1.0 mm vertical.

The patient presented with no history of sleep issues or snoring. The patient exhibited a scalloped tongue consistent with parafunctional activity. The patient’s medical history was noncontributory.

The patient had no restorative treatment other than the ceramic veneers on the maxillary laterals (teeth Nos. 7 and 10) and the right central (tooth No. 8). She reported no history of decay. Remnants of sealants were present on several posterior teeth. She reported having had orthodontic treatment as an adolescent, and the first premolars had been removed. Her third molars were also removed following the completion of orthodontic treatment in her late teens.

A comprehensive periodontal exam revealed pocket depths that were within normal ranges for the entire dentition, with one or 2 isolated areas of bleeding upon probing. She had a history of seeing a hygienist every 6 months. Home care was good, with isolated areas of supra-gingival calculus around lower anteriors and some subgingival plaque.

Aesthetic Evaluation
The patient presented with adequate incisor display at repose, with 3.5 mm of the central incisor (tooth No. 8) visible. She had a slight reverse smile line with centrals about 0.5 mm shorter than the cusp tips of her canines. The maxillary occlusal plane was relatively level, with a slight step to the buccal cusp tips of the premolars and molars from the canines. She showed just the tips of her papilla in a full smile, and her gingival symmetry was acceptable. The patient had triangular necks to her maxillary anterior teeth, with high gingival scallop (Figure 2).

Surgical Evaluation
Historically, an immediate implant was attempted, which failed prior to the restoration phase. A second attempt also resulted in failure prior to restoration. Upon presentation, active infection was noted with labial alveolar perforation and communication of the recent implant osteotomy with the anterior/mesial wall of the incisive canal (Figure 3).

Summary of Concerns
The largest surgical risk factor for this case was the redemption of the surgical site and ability to create optimal hard- and soft-tissue contours prior to implant fixture placement. The 2 previous surgeries that she endured compromised the ability to achieve optimal results. The first challenge was to resect and remove the incisive canal tissue that had grown into what should have been alveolar space. If this could be accomplished successfully, bone and soft-tissue augmentation would still be required prior to fixture placement.

From a prosthetic perspective, multiple risk factors presented. Restoring a single central is one of the most challenging procedures done in dentistry, requiring an incredible amount of effort to create a restoration that blends into the natural dentition. That challenge is magnified in a younger female patient with a relatively high smile line. The adjacent veneered teeth all had a triangular shape with a narrow emergence profile in the gingival one third. When placing a single implant amongst natural teeth, this tooth shape increases the challenge of achieving adequate papilla fill and optimal interdental pink aesthetics. We lose the ability to use increased emergence profile to put pressure on the papilla to fill the gingival embrasure if we are to mimic this adjacent tooth shape. The possible need to place new veneers on the adjacent teeth to allow us to change the tooth contour was discussed with the patient. Lastly, achieving optimal pink aesthetics would depend upon the success of the surgical part of the treatment plan, combined with the prosthetic approach. Given the history, it was reasonable to assume that we would be deficient in hard or soft tissue and may end up with a compromised aesthetic result.

Proposed Treatment Plan Surgical Phase
A 2-stage approach to alveolar and gingival reconstruction was planned. The first stage would involve the removal of incisive canal contents and complete guided bone regeneration, augmentation, and tissue grafting. Following healing from the first stage of surgery and prosthetically driven implant planning, the fixture would be placed and buried. After osseointegration, the implant would be uncovered and a custom healing cap placed.

Prosthetic Phase
Initial diagnostic records would be captured to allow for a wax-up and fabrication of a scan guide and surgical guide. A new Essix retainer would be fabricated to replace the existing prosthesis that was breaking down. A custom screw-retained temporary would be used to allow for tissue profile development and confirmation of tooth shape. Following tissue maturation, a final crown and abutment would be placed.

At the initial consultation, the shape of the existing veneers and the challenge of matching a single central one were discussed. The patient’s preference to not replace any of the existing restorations was balanced against the risk factors, and it was agreed that the final decision would be made during the temporary phase after the fixture was integrated.

CLINICAL PROTOCOL 
Surgical Phase
The maxillary anterior sextant had highly scalloped gingival contours, and papillae-sparing incisions were made with labial and palatal full-thickness flaps for surgical access. Following debridement and the removal of incisive canal contents, a guided bone regeneration procedure and crestal/labial connective tissue graft were completed by the oral surgeon using allograft/xenograft with platelet-derived growth factors (PDGFs), platelet-rich fibrin (PRF), and Emdogain, as well as a subepithelial connective-tissue graft. An Essix retainer was placed and adjusted to prevent soft-tissue compression. Following graft-site maturation, a CBCT scan was obtained and software planning of the surgical guide was completed. The implant (Bone Level Tapered NC, 3.3 x 14 [Straumann]) was chosen for alveolar conservation, and was positioned in anticipation of a screw-retained final restoration at adequate depth for a proper emergence profile. Minor labial/crestal gingival and alveolar deficiencies in the area of tooth No. 9 were corrected at the time of implant placement using additional GBR and connective-tissue grafting. The implant was indexed prior to primary closure of the soft tissue so that a custom-healing abutment could be placed during the uncovery surgery. A 2.0-mm healing abutment was used as a “tent pole” to allow space for additional connective tissue volume development. After the integration period, a prefabricated custom healing abutment was placed, and the patient was directed to proceed with the prosthetic phase of her treatment.

Prosthetic Phase
Following the uncovering of the fixture and placement of a custom healing cap to begin the process of tissue development, the patient was seen for records to fabricate custom screw-retained temporaries. The custom healing caps were removed, and stock Straumann closed-tray impression copings were screwed down to the fixtures. Radiographs were taken to confirm seating of the prosthetic parts using a closed-tray vinyl polysiloxane (VPS) (Flexitime [Kulzer]). In addition to taking a shade and digital photograghs, a facial analyzer (Kois Dento-Facial Analyzer System [Panadent]) was used to capture the aesthetic and functional information that would be used to mount the upper model. The restorations were to be completed in the MIC position due to the low functional risk following initial assessment, so the lower model would be hand articulated.

All records and information were sent to the team at Gold Dust Dental Laboratory in Tempe, Ariz, and a custom PMMA custom-stained screw-retained provisional was fabricated. The emergence profile of the provisional was created by carving the soft-tissue model and taking a best guess at what would be appropriate to create optimal tissue aesthetics. When seating the screw-retained provisional, if the goal is to move the free gingival margin apically, we want to see blanching of the tissue. This blanching is to be monitored and should disappear in about 10 minutes or fewer. If the blanching does not diminish, the emergence profile should be reduced in prominence/convexity and additional tissue pressure can be applied at a follow-up appointment, if required, to obtain the final tissue position. If the goal is to allow the tissue to drape further incisally, the clinician should reduce the prominence/convexity of the emergence profile even more than the custom healing cap. In this case, there was minimal to no blanching when the provisional was seated. So, the interproximal tissue and papilla position were managed by increasing the prominence of the mesial and distal emergence of the crown form to fill gingival embrasures and to move papilla incisally. The biologic limit is 3.5 to 4.0 mm of papilla height, and, in this clinical case, the reference was the bone on the interproximal of each adjacent natural tooth.

The custom provisional was placed, and then the tissue was monitored every 30 days. If not optimal, the emergence profile of the abutment component, or the crown form, can be adjusted until final results are achieved. The provisional was then allowed to stay in place until the tissue showed evidence of maturation to include stippling, a correct light pink color, and a noninflammatory appearance.

In this case, we needed to narrow the facial emergence profile to encourage the tissue to drape incisally in an effort to try to correct the soft-tissue defect from the original failed surgeries while maintaining papilla position. Since the patient had requested that we not replace the adjacent restorations, if possible, we were limited in our ability to increase the mesial and distal emergence profile of the crown form. This would have resulted in one square or ovoid tooth next to teeth with narrow necks and high tissue scallop. The patient was aware of this challenge and knew that the provisional was our test to see if we could get acceptable results.

The provisional was in place for about 5 months. As we monitored the tissue, it was determined that although it appeared that she had proper papilla position aesthetically, the deficiency of tissue volume or tooth volume had resulted in a terrible food trap on the distal. As a result, we revisited the original treatment plan decisions, and the patient opted to have the veneer on the other central (tooth No. 8) replaced, the gingival one-third crown shape changed to allow the 2 centrals to match, and the papilla deficiency corrected (Figure 4).

The patient was anesthetized and the ceramic veneer on the right central (tooth No. 8) removed. A 2-cord retraction technique was used for tissue management to allow for adequate flash on the impression of the natural tooth. The custom, screw-retained provisional was removed and Mach-2 Die Silicone (Parkell) used to hold the tissue form. The custom provisional was attached to an analog, and a custom, single-tooth model was created using snap set stone and Mach-2 Die Silicone. A custom impression coping was made to mimic the exact emergence profile of the provisional by adding a resin cement (SpeedCEM Plus [Ivoclar Vivadent]) around a stock closed-tray impression coping in the custom single-tooth model. This custom impression coping was then used to capture a final fixture-level impression. Final laboratory records were taken, including die shade information and photographs. The custom provisional was screwed back into place. Then, following the application of GLUMA (Kulzer) to the preparation, a single-tooth shrink-wrap veneer provisional was fabricated for the right central (tooth No. 8) using Venus Temp 2 (Kulzer).

The final veneer was fabricated from an aesthetic leucite-reinforced all-ceramic (IPS Empress Esthetic [Ivoclar Vivadent]). The final implant restoration (IPS Empress Esthetic) and lithium disilicate (IPS e.max [Ivoclar Vivadent]) for a custom abutment (Empress Veneer [Ivoclar Vivadent]) were fabricated by the dental laboratory team. The abutment was prepared to match the veneer preparation on the natural tooth. The 2 prosthetic components were designed to be bonded together in the mouth, with one final shade verification, to create a screw-retained final solution. Fabrication of the abutment and veneer in 2 pieces allows more flexibility in customizing the final aesthetics (by varying the resin layer between them as needed) and for adjustments by the laboratory without compromising the lithium disilicate abutment each time it has to be re-fired in a porcelain oven. This is a technique I use routinely in the maxillary anterior segment. The high aesthetic demands presented in restoring a single central and, in this case, the dark natural prep color made the use of this technique even more critical.

At the delivery appointment, the final abutment was seated and the screw hand tightened. The 2 veneers were tried in using a try-in paste to verify the final aesthetics, marginal integrity, and interproximal contacts. Once we had verification that the restorations would be seated, the abutment was radiographed to verify complete seating and then torqued down. The final veneers had been HF-etched in the dental laboratory and, after try-in, a universal cleaning gel (Ivoclean (Ivoclar Vivadent]) was applied for 20 seconds to the intaglio surfaces and then rinsed with water and air dried. Next, the intaglio surfaces were treated using a universal primer (Monobond Plus [Ivoclar Vivadent]) as directed. After isolation was accomplished (OptraGate [Ivoclar Vivadent]) and the access hole was covered with Teflon tape, the e.max abutment was cleaned with Ivoclean and conditioned with Monobond Plus. The veneers were seated one at a time with a light-cured resin cement (Variolink Esthetic LC [Ivoclar Vivadent]), then the margins were checked and the veneer light-tacked into place for 1 second using a 2.0-mm tip.

After seating and light-tacking the second veneer, the resin was taken to a gel phase with a second wave cure on both the buccal and lingual. The excess resin cement was cleaned easily and completely and an oxygen barrier placed using glycerin before fully curing the restorations for 20 seconds each in the gingival third, middle third, incisal third, and then the lingual. The access hole was sealed using Telio CS Onlay (Ivoclar Vivadent).

The final occlusion was adjusted to ensure light anterior contacts without fremitus in the MIC position, smooth transition to crossover, and smooth protrusive guidance. Following occlusal adjustment, the restorations were polished with ceramic polishers (Feather Lite Porcelain Polishers [Brasseler USA]) and a polishing paste (Diamond Polishing Paste [Ultradent Products]) (Figure 5).

CLOSING COMMENTS
In this clinical case, the 2 biggest challenges in completing the replacement and restoration of the upper left central incisor were (1) restoring the hard- and soft-tissue anatomy, and (2) gaining the patient’s trust related to moving forward with more dentistry after 2 prior failed attempts by the previous dentist.

Authentically sharing with patients the risks and benefits of all possible treatment plans, helping them understand the implications those plans have for them, and then allowing them to choose to proceed in a way that best fits their goals is the key to patients moving forward and feeling confident. In this case, none of us could guarantee what the surgical results would be and, ultimately, how compromised the final aesthetic results would be based on the initial compromises. What we could and did share were the options for going forward with the greatest chance for success. This was done by explaining what the next steps would be based on the alternate ways the surgical phase might turn out. Above all, the clinician must work together with the patient and all other team players involved in the planning and treatment of the case to provide the best care possible.

Acknowledgment
The author would like to thank the dental laboratory team at Gold Dust Dental Laboratory in Tempe, Ariz, for the work performed in this case.

Dr. Brady is in private practice in Glendale, Ariz. She is an internationally recognized educator, lecturer, and author. With an extensive history in leadership, she is currently director of education for the Pankey Institute. Dr. Brady has also developed a vast library of online instruction at the websites leeannbrady.com and restorativenation.com. She can be contacted via email at lee@leeannbrady.com.

Disclosure: Dr. Brady has received honoraria from Ivoclar Vivadent and Kulzer.

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The swift resolution of the patients’ immediate needs must be balanced with their emotional abilities to make permanent treatment decisions quickly after their injuries. Once stabilized clinically, the patients can better choose their permanent treatments, and the clinicians can take into account their individual emotional and psychological needs as well as other considerations, such as cost, time, and the probabilities of success.

CASE REPORT
Diagnosis and Treatment Planning
A 52-year-old female patient presented to the dental office for treatment of dental injuries sustained in a fall (Figure 1). Her chief concern was facial pain and an inability to close her mouth due to the position of the traumatized teeth. Her upper lip lacerations had been sutured in the hospital ER during the evening of the fall. No teeth were completely avulsed, although the roots and surrounding cortical bone were clearly displaced outside of the maxillary alveolus (Figures 2 and 3). The soft tissue was completely intact around the teeth, and blood flow was not compromised. The specific findings were as follows:

Figure 1. One week after the inury occurred, swelling was still present and the stitches done in the ER remained in place.

• Tooth No. 4 in occlusion with Class II mobility;
• Tooth No. 5 completely displaced palatally;
• Tooth No. 6 intruded with Class III mobility;
• Tooth No. 7 intruded palatally with Class II mobility, enamel cracks evident;
• Tooth No. 8 palatally displaced, Class II mobility, fractures to clinical crown; and
• Tooth No. 9 had a chipped incisal edge.

The diagnostic findings and permanent treatment options were discussed with the patient, including the prognosis of each approach. While the overall prognosis of the teeth was poor, the removal of the displaced teeth and debridement of fractured bone would leave a catastrophic alveolar defect. Reconstruction was possible, but the process would be extensive and likely result in an overall aesthetic compromise. Therefore, as an immediate treatment, the patient elected to preserve the teeth and, thus, the bone and soft tissue. She was made aware that the endodontic therapy required to preserve the teeth might fail and necessitate removal of the teeth and reconstruction in the future.

Figure 8. Tooth position prior to preparation. Moderate reduction was necessary for teeth Nos. 6 and 7 (due to their more facial positon in the arch) and on the distal aspects of the central incisors (which were wider and more flared than ideal).	Figure 9. After minimal preparation, the shade was selected.

Oral Surgery
While under intravenous sedation, the patient’s displaced teeth were manually repositioned to allow for stable and repeatable occlusion. The teeth were stabilized in this position using orthodontic wire and composite resin. No incisions were made to avoid compromising blood flow to the structures around the avulsed teeth. The patient was then referred for endo­dontic treatment.

Endodontic Treatment
Two weeks after the accident, teeth Nos. 4 to 8 were nonresponsive to cold and very percussion sensitive. Palpation sensitivity was also noted over the roots of these teeth. Tooth No. 9 exhibited a mesial coronal fracture with various cracks, but all pulp tests were normal. Tooth No. 4 had a root fracture in the apical 3.0 mm, but prognosis was still deemed favorable. Endodontic therapy was completed on teeth Nos. 4 to 8, with a one-month recall set to reevaluate tooth No. 9 (Figures 4 and 5).

Figure 14. Our happy patient continues to feel fortunate that she could save her teeth and satisfy her aesthetic desires.

Restorative Plan
After completion of the endodontic therapy, the patient returned for an evaluation and discussion of her long-term restorative options. The greatest long-term risk was loss of the injured teeth through resorption, endodontic failure, or bone loss. She stated that a fixed restorative option was important to her, as was an excellent aesthetic outcome. One option discussed was to extract teeth Nos. 4 to 8 due to their questionable long-term prognosis. This would require bone grafting and implant placement, with the possibility of a soft-tissue defect. She rejected the extraction option due to the unpredictable aesthetic outcome, and also due to her concerns about the healing phase and appearance of the temporary restorations. The other option was to keep teeth Nos. 4 to 8, and to place veneers to establish proper smile design and to restore the broken teeth. A minimal amount of tooth preparation would be required for veneers, so the teeth would not be compromised further by the restorative treatment. The risk to this approach was that the cost of the veneers would be lost if the teeth had to be removed in the future. However, the veneer option did not involve a removable appliance or long-term provisionals, incurred no surgical costs, and was a relatively straightforward aesthetic restoration. She opted for no extractions, and for restoration with veneers.¹

Clinical Records
Clinical records were obtained at the start of the restorative phase, which began 8 months after the injury occurred (Figures 6 to 8). A thorough functional exam revealed acceptable function.² There was no need to alter her vertical dimension, so the existing maximum intercuspation position could be used. A series of digital photos and a video (Canon 70D [Norman Camera]) were taken to analyze the aesthetic relationships between the face, teeth, and tissue. The use of video can capture maximum lip movement and tooth reveal during speech that static photography does not always record.³ Functional records were taken using the Kois Dento-Facial Analyzer (Panadent), a bite registration (Futar D [Kettenbach LP]) and a stick bite. These, along with a known metric (such as the length of No. 8), was used to verify the accuracy of casts and mounting for lab purposes. The patient reported that she loved the smile she had before the accident, so she brought photos taken before the injury to assist in recreating that smile. These records were sent to the lab to create a wax-up and silicone matrix to replicate the shape and contours of her old smile as closely as possible.

Restorative Phase: Clinical Protocol
A study model was used that indicated where tooth reduction would be needed to completely seat the silicone matrix (Virtual Putty [Ivoclar Vivadent]). Since the reductions were made entirely in enamel, no anesthetic was used. The silicone matrix was loaded with a bis-acryl provisional material (Luxatemp Ultra [DMG America]) and placed over unprepped teeth. The material was allowed to fully cure before removing the silicone matrix. Smile design was initiated by determining the final desired position of the teeth. The tooth shapes and position in the bis-acryl were evaluated for shape, contour, and alignment with normal lip movement. This technique ensured that tooth reduction was only done where necessitated by the final smile design.⁴

Once both the patient and dentist were satisfied with the final smile design, the patient was anesthetized. With the bis-acryl stent in place, depth cuts were made in the cervical, middle, and incisal thirds of the facial surface and preparations were finished and refined. A vinyl polysiloxane (Aquasil Ultra [Dentsply Sirona Restorative]) final impression, prep shades (Figure 9), and a bite registration were taken. The silicone matrix was again filled with the bis-acryl provisional material and placed over the teeth. After approximately one minute, the bis-acryl reached initial set. It was then removed and allowed to fully cure extraorally. The provisionals were then trimmed and polished. The teeth were spot etched (Ultra-Etch [Ultradent Products]) and an adhesive resin (OptiBond FL [Kerr]) was applied to the intaglio surfaces of the provisionals and seated. Before the final cure, a microbrush was used to clean off any excess resin, and a rubber tip stimulator was used to clear the interproximal areas. The posterior contact points were refined with articulating paper (TrollFoil [TrollDental USA]) and verified with shimstock. The chewing envelope of motion was then evaluated by having the patient sit up and chew a piece of gum with 200-µm articulating paper (Bausch) in place. All streaks on the linguals of the maxillary centrals and laterals were removed to ensure there was no friction during function.⁵

The patient returned one week later to evaluate the occlusion and to address any postoperative concerns. She reported no problems. Her speech and chewing felt normal and she had no negative impact to her lifestyle. She wore the provisionals a few more weeks to ensure that she remained satisfied with the aesthetics, particularly in the areas of bone/tissue loss where the clinical crown appeared longer. If that had been a concern, the use of pink porcelain to mask the length of the clinical crown could have been considered. After 4 weeks, she opted to forego the addition of pink porcelain in the final restorations as her normal lip dynamic did not reveal the excessive clinical crown length⁶ (Figures 10 and 11). Full occlusal, facial, photo, and video documentation were done again. This information was sent to the dental laboratory team (Matt Roberts, CDT of CMR Dental Lab [Idaho Falls, Idaho]) to capture any changes that had occurred during the 4 weeks of wearing the provisional restorations in the final restorations.

Six weeks later, the patient was anesthetized and the provisionals were carefully removed. Small tags of resin will often remain on the teeth, particularly if not thoroughly removed where the tooth was spot etched, and will interfere with the final seat of the restorations. These areas of adhered resin were carefully removed using a sharp scaler. The teeth were microabraded using 27-µm aluminum oxide at 40 psi (PrepStart H20 [Zest Dental Solutions]), treated with 35% phosphoric acid for 15 seconds, and then rinsed and gently dried (not dessicated). Unfilled adhesive resin (One-Step [BISCO Dental Products]) was applied with a brush, air-thinned, and then light cured. The internal surfaces of the restorations were etched with 35% phosphoric acid, silane (RelyX Ceramic Primer [3M]) was applied, and then a layer of light-cured translucent RelyX Veneer Cement (3M) was applied. The IPS e.max (Ivoclar Vivadent) restorations were placed on the teeth and then spot cured.⁷ Excess cement was removed, and the final light curing was completed. Finally, the occlusion was refined as described earlier (Figures 12 and 13).

After completion of the restorative phase, an upper occlusal splint was fabricated and delivered to ensure the proper splinting of teeth and to also protect against any possible parafunctional habits.

CLOSING COMMENTS
Trauma that results in fractured and displaced teeth can have significant negative aesthetic, functional, and psychological impacts on patients. Facial traumatic dental injuries are emergencies that the dentist must be able to assess rapidly and manage appropriately. Once initial stabilization has taken place, the risk assessments and prognosis must be reviewed with the patient to determine the treatment plan that best suits his or her goals. Finances, aesthetics, function, and length of treatment are considerations, as well as reasonable predictability. The patient presented in this clinical case report has functioned comfortably with no adverse complications for more than 3 years now. She continues to be very thankful that she chose to save her teeth (Figure 14).

Acknowledgement
The author would like to acknowledge CMR Dental Lab (Idaho Falls, Idaho) and thank Matt Roberts, CDT, for the ceramic restorations fabricated in this case.

References

1. Bakeman EM, Kois JC. Maximizing esthetics/minimizing risk: the line of predictable success. Inside Dentistry. 2005;1:16-24.
2. Dawson PE. Centric relation. In: Dawson PE. Evaluation, Diagnosis, and Treatment of Occlusal Problems. 2nd ed. St. Louis, MO: Mosby; 1989:28-55.
3. Coachman C, Calamita MA, Sesma N. Dynamic documentation of the smile and the 2D/3D digital smile design process. Int J Periodontics Restorative Dent. 2017;37:183-193.
4. Terry DA, Leinfelder KF, Geller W, eds. Aesthetic and Restorative Dentistry: Material Selection and Technique. Stillwater, MN: Everest Publishing Media; 2009.
5. Kois JC. Functional Occlusion: Science Driven Management Manual. Seattle, WA: Kois Center; 2011:79.
6. Rufenacht CR. Principles of Esthetic Integration. Chicago, IL: Quintessence Publishing; 2000.
7. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach. Chicago, IL: Quintessence Publishing; 2002.

Dr. Seay, a 2002 graduate of the New York University College of Dentistry, maintains a private practice in Mount Pleasant, SC, and is an accredited member of the Academy of Cosmetic Dentistry (AACD). She is a clinical instructor at the Kois Center in Seattle, Wash. Dr. Seay has published articles covering the art and techniques of aesthetic dentistry and serves on the advisory boards of several peer-reviewed journals. She was nominated in 2012 as one the “Top 25 Women in Dentistry” by Dental Products Report and has been listed in Dentistry Today’s Leaders in Continuing Education since 2017. She can be reached at (843) 375-0395 or via seayamanda@gmail.com.

Disclosure: Dr. Seay reports no disclosures.

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