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Dr Gar Duen Wongs Presentation on Aesthetic Dentistry

Aesthetic Dentistry Dr Garduen WongBDS,BSc(Hons)

Sapphire Clinic

Dr Garsing Wong, graduate of Auckland University in 1991 with a Bachelor of Medicine & Surgery. Dr Wong is the Censor for the New Zealand College of Appearance Medicine and an Examiner and Lecturer for the College of Urgent Care Physicians.


The Story behind this blog was that Dr Garduen Wong was invited to present his work "The Synergy of Appearance Medicine & Cosmetic Dentistry" at the NZ College of Appearance Medicine Annual Scientific Conference on 19-22 Sept 2012, Queenstown. After lots of encouragement from Margaret and Garsing, Garduen finally compiled this blog, to enable patients to see how Aesthetic Medicine and Dentistry can give optimal results for his patients.

Dr Garduen Wong B.D.S. (Otago) BSc.(Hons) Newmarket Dental Care 18 Morrow Street ( Parking Opposite 277 Newmarket Westfield Shopping Centre ) Ph: 09 524-8399 www:

Occlusal Vertical Dimension increased, colours changed. Note the improvement of facial height & fullness of the lips. Patient now has a good foundation for appearance medicine


Porcelain teeth have significantly improved smile line by changing the shapes & colours. Treatment time to completion 2-5 months, depends on complexity & patients wishes.

Patient declined orthodontics for protrusive teeth & had mild tetracycline staining. Treatment completed in 3 months.

Teeth colours changed, length of teeth increased & improvement on buccal corridor. Teeth follow soft tissue architecture of the lips.

Improve smile by lengthening teeth with composite restorations, which is more conservative treatment compared to porcelain veneers or crowns.

Patient concerned with diastema (Spaces in between teeth) colours & sizes of teeth. Lava 3M zirconium crowns made. Again patient declined orthodontics.

Improved smile with changes in colours, shapes and the amount of teeth displayed. Also wished to have more translucency to teeth shapes to give a more "life like" & natural appearance. ( See following page )

Left Photo - Medium Smile displays 20% to 80% teeth showing. Right Photo (Top) - Low Smile displays maximum of 20% teeth showing. Right Photo (Bottom) - High Smile displays 100% teeth showing & gum tissues.

Replacing amalgam restorations with crowns, heavy toothbrush abrasion was present, hence the decision for crowns as opposed to porcelain inlays.

Bridge treatment 16^^13 ( 4 units with stress-breaker ). We were able to improve the occlusal plane & colours significantly.

Bridge constructed to replace 2 missing maxillary teeth, patient declined dental implant option. Also bridge constructed 35^37 mandibular teeth.46 Temporary composite crown.

Left Photo - Completed case with porcelain bridge. Top Right Photo - Discoloured lateral tooth. Bottom Right Photo - Temporary Bridge in place.

Before and after Photos. Patient wished to have natural colour look to match remaining teeth. Treatment is not completed at this stage, will need to improve the buccal corridor.

Trauma resulting fractured tooth from accident, restored with composite resin. Fissure Sealants & Gold Inlays for longevity of restorations.

Toothbrush abrasion on maxillary 22,23,24 & mandibular 34,35 replaced by composite. This prevents further sensitivity of hot/cold & possible further risk of endodontic treatment

Occlusal Vertical Dimension increased, colours changed. Note the improvement of facial height & fullness of the lips. Patient now has a good foundation for appearance medicine.

New Acrylic Dentures made with dental implants & locators to improve retention.

Treatment Planning Sequencing

Dental Clinical Examination including dental radiographs OPG, BW & PA's Clinical Photos, Study Models & Diagnostic Wax Up if necessary. 2) Referral to dental hygienist & address pain symptoms if any, triage of preventive aspects e.g. avoid root canal therapy if possible, caries, maintenance, finally cosmetics. Shapes, colours, treatment options & time parameters discussed. 3) Occlussal analysis to avoid dentition collapse, periodontics, food impactions & optimal ease for oral hygiene. Sequencing, phasing treatment discussed. 4) Partial dentures, bridges or dental implants to replace missing teeth, get optimal occlusion, avoiding bruxism/attrition & complications discussed. 5) Longevity of treatment using long term materials such as porcelain and gold, good contours & shapes to make oral hygiene easier for patients. 6) Maintenance by seeing dental hygienist on a regular basis, usually 6 monthly or less if patients have periodontal issues.

Before & After treatment photos showing completed case. Improved with colours, shapes, increased length/height of teeth & buccal corridor. Time of 3-6 months to complete treatment, depends on treatment required.

Study Models taken, then diagnostic wax up made, trial smiled before we started on definitive treatment.(Temporary crowns with increased OVD/height) Crowns used for 6 weeks to ensure colour, heights & phonetics correct before next step

Colour selection, canine guidance build up on 13 to increase OVD in composite, then crowns with gold occlussal 15,14,13 and E-Max crowns on anterior maxillary teeth. ( OPG Radiograph on completed case )

Patient had tetracycline staining & caries due to reduction of saliva flow resulting from radiotherapy for naso - pharyngeal carcinoma. Porcelain Crowns and Composite Veneers. The patients left upper lateral incisor positioning was improved.

Diagnostic Wax Up to Change teeth shapes & length of teeth / Before & After Treatment. This is planned & discussed with patient before we commence treatment.

Facial collapse due to early lost of teeth prematurely, dental implants can prevent bone resorption, see bone levels on page 29 & 32 - following case (Dental radiograph thickness of mandible in comparison to this)

Dental OPG Radiograph with 2 x Astratech dental implants & intra oral photos. Surgical Placements of dental implants carried out by Dr Richard Longbottom.

Astratech Dental Implant Analogues on Stone Models & in mandible. With -/F & Locators under denture for improved retention.

  PIB (Prosthetic Implant Bridge  6 x Dental Maxillary Implants. Also 6 x Dental Mandibular Implants (Porcelain Bridges & Crowns)

Maxillary implants x 6 Nobel Biocare & Multiunit abutments, ( PIB ) Articulated PIB (Prosthetic Implant Bridge). Dental OPG radiograph of completion. A titanium frame was constructed & attached with prosthetic screws.

Bridges x 2 (Implants 37^^34, 42^32, 46 & 47 ) Gold Abutments & Porcelain teeth made. Gutta Percha placed over abutment screw access cavities.

Before treatment & completion of treatment.We decided to make the three mandibular incisors not completely straight to give a more authentic & natural appearance. Titanium frame fabricated & attached with prosthetic screws.(Nobel Biocare)

Stages of Single Dental Titanium Implant Straumann Fixture ( Before & After ) Titanium Abutment used & then Crowned.

From Left: Before with fractured 21, Stage with fixture registration coping & Completion. Straumann Dental Titanium Implant with Ti Abutment, then crowned.Surgical placement by Dr Michael Danesh-Myers.

Dental Implants to replace terminal dentition with periodontal disease. Dental implants placed by Dr Richard Longbottom ( Astra & Straumann ) EVERY FACE TELLS A STORY......

Disclosures of Dr Garduen Wong Other Information

Previously postings at Auckland Hospital, New Zealand Defence Force, Accident and Emergency Clinics in Remuera and Takapuna, General and Cosmetics in Newmarket.

Member of the following Associations:

ITI (International Team for Implantology), NZDA (New Zealand Dental Association) New Zealand Society of Endodontics (Inc), NZACD (New Zealand Academy Cosmetic Dentistry) & NZIMID (New Zealand Institute Minimal Invasive Dentistry)

Presentations at following Conferences:

NZCAM ( NZ College of Appearance Medicine ) - Synergy of Dentistry & Medicine ! ADA Fiji Conference - Orthodontics & Restorative Dentistry for Optimal Results ! ADA Seminar Brisbane Australia - Cosmetic Dentistry Complications. ! NZDA Meeting Colorado USA - Dental Implant Prosthesis & Complex Full Mouth Reconstructions

Garduen Wong, graduated from Otago University NZ in 1986. Initially started working in Auckland Hospital then in Newmarket in 1991. Areas of interest are oral preventive dentistry, Cosmetic Dentistry & Aesthetic dental implants. Outside interest includes history, philosophy, photography,Tai Chi & Cycling. He is married with one adult son who is at university.

Gold Inlays stand the test of time.

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