CATEGORY AUSTRALASIAN DENTIST 69 CLINICAL high level of aesthetic precision. The patient presented with strong expectations and a clear desire for an outcome that would be visually undetectable within the natural dentition – particularly on the right side of the smile. To remain conservative, the restorative scope was limited to a three-unit reconstruction spanning teeth 14–12. The remainder of the dentition was in excellent condition, displaying a high degree of natural translucency and internal character – making material selection and integration especially critical. A diagnostic wax-up was therefore used to assess space distribution and tooth proportions, revealing a narrower available space in the upper right quadrant compared with the contralateral side. Rather than pursuing strict symmetry, the design focused on achieving optical balance and natural harmony within these constraints. Tooth morphology was refined selectively. The existing form of tooth 12 was largely preserved in line with the patient’s preference, while adjustments were made to the canine and first premolar to reduce bulk and improve spatial balance. From a technical perspective, this created a scenario where precise control of form, transition, and surface character would be essential to achieving a seamless result. Colour planning was approached in parallel, allowing final shade evaluation to be carried out on a stable baseline prior to definitive ceramic work. This ensured predictable material behaviour during the build-up phase and provided a reliable foundation for aesthetic integration. From a technical standpoint, this case offered an appropriate platform to evaluate a high-strength zirconia workflow using e.max ZirCAD Prime, where translucency is derived primarily from the material itself and refinement is achieved through controlled morphology, layering strategy, and surface characterisation. Case Planning and Bone Grafting: One of the patient’s primary concerns from the outset was the loss of soft-tissue volume at the bridge site. This was particularly significant in the aesthetic zone, where crown margins were visible and soft-tissue deficiencies became apparent during smiling and speech. Over time, the patient had developed a subconscious habit of concealing the right side of her mouth, highlighting the psychological impact of the aesthetic compromise. These concerns were identified through detailed clinical and technical consultations, photographic assessment, and open interdisciplinary communication. Addressing both the aesthetic and psychological dimensions of the case required a coordinated, staged approach, resulting in an extended treatment timeline – spanning several months rather than the few weeks typically associated with a standard three-unit bridge. As part of comprehensive case planning, site-specific bone grafting and ridge augmentation were undertaken to optimise both hard- and soft-tissue conditions prior to definitive prosthetic reconstruction. Clinical evaluation of the edentulous region associated with tooth 13 revealed ridge deficiency that would have limited the ability to achieve an optimal aesthetic and functional outcome. Following assessment, ridge augmentation was recommended to increase tissue volume, support future pontic design, and enhance long-term aesthetic integration. The ridge augmentation procedure was performed under local anaesthesia with adjunctive oral sedation. A full-thickness mucoperiosteal flap was elevated via sulcular and vertical releasing incisions extending between teeth 12 and 14. Following meticulous debridement and irrigation of the recipient site, particulate xenograft material (Bio-Oss) was placed and stabilised using a resorbable collagen membrane (Bio-Gide). Tension-free primary closure was achieved after periosteal release, with the flap coronally repositioned and secured using fine resorbable sutures. The procedure was well tolerated, and the patient experienced an uneventful immediate post-operative recovery. Postoperative instructions were provided, and follow-up appointments were scheduled to monitor healing prior to progression into the restorative phase. From a restorative perspective, this surgical intervention was critical in establishing a stable and biologically favourable foundation for the subsequent provisional and definitive prosthetic stages. Adequate ridge volume allowed for more controlled pontic emergence, improved soft-tissue support, and reduced reliance on prosthetic camouflage techniques at later stages of treatment. The timing and execution of the grafting procedure were therefore integral to the overall aesthetic planning and final outcome of the case. Temporary Review and Design Validation: The temporary review was conducted once bone grafting and soft-tissue healing had stabilised, allowing an accurate assessment of both form and gingival integration. The temporaries were fabricated directly from the diagnostic wax-up, providing a reliable reference for evaluating the proposed design in situ. From a shape perspective, the patient was very comfortable with the overall form, and no major modifications were required. The presence of subtle natural imperfections was viewed positively, Figure 7: Temps in situ: Close-up smile frontal view Figure 8: Temps in situ: Retracted frontal view Figure 9: Temps in situ: Close-up smile lateral view (right) Figure 10: Temps in situ: Retracted lateral view (right) Figure 11: Temps in situ: Close-up smile lateral view (left) Figure 12: Temps in situ: Retracted lateral view (left)
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