Facial development with the HomeoblockTM Appliance, in conjunction with the placement of porcelain laminate veneers: a case study

A healthy 41-year-old male presented for treatment and expressed a desire for smile enhancement. His chief complaint was that his teeth were discoloured and that his upper lip was too thin and flat and combined with deep facial lines made him look old. The oral hygiene status was good and there was no active gingival or periodontal disease. Extra-oral and intra-oral photos and stereophotogrammic photos (Figure 1) as well as cephlometric and panorex x-rays were taken followed by alginate impressions. An upper HomeoblockTM removable functional device was fabricated. The device consists of adams clasps on the second bicuspids, a palatal expansion screw and a Hawley labial bow from cuspid to cuspid, flap springs in contact with the incisors and bicuspids, and a unilateral bite block. On insertion, the patient was instructed to wear the appliance every evening and throughout the night. Once a week the expansion screw was advanced one full turn 3 (=0.25 mm) the patient reported for clinical adjustments and observation every three weeks; intraoral photos were taken at each visit (Figure 2). There was palatal expansion after six months treatment with the HomeoblockTM appliance. Porcelain laminate veneers were placed from second bicuspid to second bicuspid and facial photos were taken. Post treatment photos show a bigger and brighter smile more prominent cheekbones with reductions in the lines of the face (Figure 3). Stereophotogramic images show a fuller upper lip in the post photo (Figure 4) .To evaluate the facial changes the surface colour and texture are removed (Figure 5). To confirm the changes that have taken place a morphometric analysis was carried out by super imposing the post face photo over the pre face photo in 3D space, using the software provided by Orthodontics