I actually think the case looks awesome and real world. To many times people show these perfect cases that arent realistic or is done one time. In todays economy where money is a factor compromises are done due to lake of the ability to do everything needed.

The case is awesome bravo

I was able to potentially avoid an esthetic failure deemed by the patient by transferring the diagnostic wax up on the stone casts to her teeth with a direct composite mock up. This allowed her to evaluate the proposed changes and to "sign on" to the changes I wanted to make (see image with the Chu Gauge). When she saw this directly on her teeth, the first comment that she made was that they appeared too big and too square. In order to counteract this undesirable outcome and still be able to create the correct proportions, open embrasures were the visual compromises that gave her the feeling that the teeth were "neither too big nor too square." This was acceptable for one big reason, she never shows the gingival 1/3 of her front teeth because the upper lip shrouds this area. The fact is the only reason you are able to see this issue is because you have the benefit of seeing the unnaturally and fully retracted smile. Your question highlights a very important point we should all take away from this case. If we are not careful we can cause an esthetic failure by over-treating and over-correcting our patients. This case demonstrates a way to avoid potential esthetic failures by using a direct composite mock up that the patient can evaluate proportion, shade and the overall appearance of her new smile before irreversible changes are made. The Chu Gauge was just another tool that allowed me to quickly and objectively evaluate the correct proportions.

Good question. First, I want to remind you that this is an elective procedure. I presented her with several options. There were a couple of reasons why she chose not to do anything about the gingival discrepancy. The first reason is that she had no desire to go through anymore surgery. The second reason is that she is unable to raise her smile high enough to show the discrepancy; therefore, surgical intervention was unnecessary. The third reason is that if she chose surgical intervention to even the gingival margins, there would have been a greater chance of creating a larger "black triangle" than she already had. Hypethetically, if she chose surgery, the only way to correct or minimize the black triangle appearance would have been to create a longer midline interproximal contact point. That choice would have resulted in central incisors that appeared too square. This concern was confirmed when I applied the direct composite mock up on her teeth prior to any surgery and when she saw this her concern was that the teeth appeared "too square". The mock up helped lead to her decision to decline surgery.

Hu-Friedy makes them. They can be used in multiple ways. Here are a couple of references to learn more about them.

A Biometric Approach to Aesthetic Crown Lengthening: Part I—Midfacial Considerations
Chu SJ and Hochman MN,
Pract Proced Aesthet Dent 2008;20(1):17-24

http://www.hu-friedy.com/innovation/innovation.aspx?alias=Aesthetics

Thanks for your comments and Happy Holiday's to you as well.

I like the Chu Guide. The key to it though is the incisal edge must be set in order to have the devise give you accurate and transferable information. In this case, it was good to confirm the esthetics of the wax-up by placing a vacuum-formed matrix created from the wax-up. I filled it with LuxaTemp and applied it directly to the teeth and prior to preparation so I could visualize the esthetics using something that was reversible and simple. Thank you for your compliments and questions.