A thorough examination was performed and a Kois deprogrammer was fabricated prior to proceeding forward with diagnostic mounted models to help ascertain the correct position of the mandible. The Kois appliance proved quite beneficial as Angela experienced quick relief in the muscle tension, related a history of no further grinding, and allowed a diagnostic mounting to be performed reasonable assurance that centric relation was attainable.

A treatment plan was presented that included Invisalign treatment, occlusal equilibration, and maxillary anterior restorative dentistry. The goal of the Invisalign treatment was to align the maxillary teeth in order to optimize the esthetic result of the restorative dentistry and to expand the buccal corridor in the maxillary bicuspid region. Invisalign treatment started in October 2007 and ended in March 2008. This was followed by using a Kois appliance to assist in performing a full occlusal equilibration in order to optimize occlusal forces bilaterally in centric occlusion/relation prior to commencing restorative treatment.

Restoratively, Gold Dust fabricated teeth #5-12 utilizing Empress Esthetic and #14 the material selected was an eMax pressed crown. During the time of preparation gingival recontouring with the diode laser was performed after careful assessment of the biologic width.