Designing a Complete Smile from Incomplete Dentition: A Prosthodontic Case Report

Abstract

Background: Esthetic rehabilitation in patients with congenitally missing anterior teeth presents a complex clinical challenge, particularly when associated with generalized spacing and altered tooth proportions. Contemporary prosthodontic treatment requires integration of esthetic principles, functional considerations, and predictable restorative planning to achieve a harmonious outcome. Case Presentation: A 45-year-old female patient reported with a chief complaint of an unaesthetic smile. Clinical examination revealed congenitally missing maxillary and mandibular lateral incisors associated with generalized spacing of the anterior dentition. Radiographic and clinical evaluation also revealed an endodontically treated mandibular right first premolar (44) with extensive loss of coronal tooth structure. Various treatment alternatives, including orthodontic space redistribution and implant-supported rehabilitation, were discussed. The patient elected fixed prosthodontic rehabilitation. Endodontic treatment of the planned abutment teeth was followed by post-and-core restoration of 44, with 45 incorporated as an additional abutment. Diagnostic impressions and face-bow transfer were performed, and the casts were mounted on a Hanau semi-adjustable articulator. A diagnostic wax-up was developed to establish appropriate tooth proportions, spatial distribution, and occlusal relationships. The wax-up was incorporated into a digital workflow for guided tooth preparation and fabrication of CAD/CAM provisional restorations. The provisional phase facilitated evaluation and refinement of esthetics, phonetics, occlusion, and patient acceptance prior to fabrication and cementation of the definitive fixed prostheses. Conclusion: This case demonstrates the application of a systematic prosthodontic and digital workflow for the esthetic rehabilitation of congenitally missing anterior teeth with generalized spacing. Integration of diagnostic wax-up, guided tooth preparation, and CAD/CAM provisionalization facilitated controlled management of tooth proportions and spatial distribution while enabling patient participation in the esthetic treatment process.