INSIDE DENTISTRY—NOVEMBER/DECEMBER 2007 Inside Esthetics

2 INSIDE DENTISTRY—NOVEMBER/DECEMBER 2007 inside EsTHetics enamel fullness. Traditional simple tech- A Trio of Techniques for Assuring niques could be employed using depth- cutters and standard veneer preparation (Figure 7).5,6 Predictable Results The original length of the patient’s centrals was just shy of the wet-dry line Joyce Bassett, DDS of the lower lip (Figure 2). Lengthening these teeth would interfere with her pho- Do you ever wonder where to take wax-up) bonded over the unprepared teeth. maxillary bonded-porcelain restorations, netics; therefore, the original incisal-edge off tooth structure when preparing a dif- Then the original technique, employing recontouring of the canines, and future position could not be altered. Calipers were ficult case? Is your laboratory team frus- depth guides on the facials of these provi- lip fillers in the Cupid’s bow area of the lip. used to measure 2 mm from the incisal trated at times with the preparation design sionals, facilitates routine porcelain veneer The patient’s time constraints required edge. The porcelain would overlap the of your case? Is it difficult to obtain the preparation. This article presents three immediate tooth preparation; therefore, incisal and terminate on the lingual surface. final esthetics because you took off too different case types, ranging from simple a pretreatment wax-up was not performed This would add strength to the ceramics, much tooth structure here, and not enough to complex, in which tooth preparation and the case was prepared. provide a vertical stop during cementa- there? Do you realize your preparations are design principles and indices are used. tion, and give the ceramist room to estab- the guide for the final esthetics? Preparation Design lish the depth of incisal translucency and There are techniques to assure pre- CASE ONE Current preparation techniques recom- incisal effects.3 dictable and repeatable results, guaran- A patient presented with rotated, malpo- mend the use of depth guides to ensure Provisional restorations were fabricated teeing conservative tooth preparation and sitioned maxillary and mandibular teeth proper enamel reduction. This technique using direct-composite freehand bond- still meeting current esthetic standards. (Figure 1). She was happy with her dom- is only beneficial when the teeth are in ing. Calipers were used to measure the The use of these techniques will simplify inant centrals, but was looking for a more proper arch form with no facial enamel widths to assure symmetry of the con- difficult space-management cases and symmetrical smile. She had limited funds deficit.2 In an improper alignment case tralateral provisional restorations (teeth systemize routine procedures.1 Innovative and time. The primary clinical recommen- where the teeth are rotated lingually or Nos. 8 and 9 and teeth Nos. 7 and 10, re- preparation designs, such as those for porce- dation was orthodontic management. She labially, it is necessary to remove the pro- spectively) (Figure 8). lain laminate veneers, are much less inva- refused orthodontics and requested a treat- truding portion of the misaligned tooth.3 Once the patient’s expectations of the sive than complete crown preparations. ment plan that could be more expeditiously When evaluating from the occlusal, the provisional esthetics were established, a The goal is to restore function and esthetics executed. She had been using an at-home dentist must visualize, then align the arch record of the provisionals and photographs at a minimal biologic cost. However, tooth bleaching system and claimed that the form before the definitive preparation begins were sent to the ceramist to serve as a tem- preparation requires the execution of a color was as white as it was going to get. She (Figure 3). In this case, the protruding por- plate in the fabrication of the final pros- combination of meticulously planned tech- was happy with the shade and did not want tions of the misaligned tooth were removed thesis. The most important provisional niques. In the past, the dentist would visu- to attempt a Zoom!® power bleaching with a diamond bur (Figure 4). photograph for the ceramist was a full-face alize the final outcome and prepare the (Discus Dental, Culver City, CA). A com- A rotated tooth will not occupy the image with retractors. The ceramist eval- teeth within these boundaries, leaving large prehensive history and physical was per- same mesial-distal diameter as its con- uated the incisal-edge position relative margins of error. Depth guides were used formed. No temporomandibular joint tralateral counterpart. The difference must to the interpupillary line and the angle of to ensure proper facial reduction, but the (TMJ) disorders, periodontal, or periapical be measured and equalized by removing the dental midline (Figure 9). teeth had to be in the proper arch form pathologies were identified. She had no the adjacent tooth without causing a dis- The delivery appointment entailed try- and not be deficient facially in order for occlusal wear and demonstrated acceptable crepancy in the ultimate width of the cen- in, cementation of teeth Nos. 7 through 10, the depth cutters to ensure accuracy. occlusal function (Figure 2). tral incisors. In this case, the distal surfaces and an esthetic evaluation of the canines. Smile design principles—midline, cant- The cosmetic analysis revealed a low of both centrals were recontoured to ac- The canines were recontoured after final ing, arch form, and buccal corridor expan- smile line as a result of Gortex implants commodate the added space necessary approval of the prosthesis esthetics. This sion—are parameters to consider when placed in her lips 10 years earlier. This cre- to make the two laterals the same width helped in the management of patient ex- preparing teeth. Evaluating these princi- ated an asymmetrical backdrop that had (Figure 5 and Figure 6). pectations and also gave the ceramist the ples leads to working from the final out- to be addressed. The right lateral was rotat- The midline was evaluated for canting opportunity to maximize the esthetics of come and tracing the steps backward to the ed, the canines were protruding, and the and proper mesial-distal placement.4 The teeth Nos. 7 through 10 using the natural, preoperative state. Today, diagnostic wax- bicuspids were lingualized. There was old angulation of the midline is extremely unaltered position and morphology of ups based on these smile design principles composite bonding on the facials of the important when focusing on the symmetry teeth Nos. 6 and 11. A medium-grit dia- are fabricated and indices are used over the centrals. Ten maxillary units were prescribed and balance of the smile. Because it was mond veneer bur was used to recontour unprepared teeth to guide the dentist in to correct all of these parameters. Because acceptable in this case, there was no reason the bulges of the native canines so that tooth removal. This has led to another the patient felt that her lip covered most to alter this contact. When these steps were the facial contours blended (Figure 10). technique that involves the prefabrication of these issues, she chose a more conser- achieved, the case was in appropriate arch The patient was pleased with the final of provisionals (made from the diagnostic vative treatment plan, calling for only four form with the correct amount of facial esthetics (Figure 11). Joyce Bassett, DDS Private Practice Scottsdale, Arizona Figure 1 Preoperative view. Note the rotated Figure 2 Note the low smile line because of the malpositioned teeth. Gortex implants and long central incisors just shy of the lower lip. INSIDE DENTISTRY—NOVEMBER/DECEMBER 2007 EsTHetics 3 Figure 3 Preoperative occlusal view. Note the Figure 4 Aligning the arch form by removing Figure 5 and Figure 6 The lateral spaces were measured and equalized by the removal of tooth protruding portion of the lateral incisor. the protruding portion of the misaligned tooth. structure on the distal of the centrals. Figure 7 Depth-cutters were employed to ensure Figure 8 All contralateral widths were measured Figure 9 The ceramist uses this photo to evaluate Figure 10 Recontouring of the protruding portion the proper amount of enamel reduction. to ensure symmetry. that the midline of the centrals is perpendicular of the canine after final cementation of the ceramics to the interpupillary line. on teeth Nos. 7 through 10. Figure 11 Final occlusal view. Note the sym- Figure 12 Case 2: Preoperative ideal smile Figure 13 The additive wax-up. Figure 14 The provisional was added to the metry and arch-form correction. design principles with lingualized lateral incisors. tooth and the photograph taken with shade tabs before dehydration of the dentition occurred. CASE TWO mines the tooth preparation. Inadequate of the tooth would have occurred and the ure 19). Her maxillary restorative treatment A patient presented with a smile that met reduction of the tooth will hinder the deliv- final esthetics would have been compro- plan called for seven bonded-porcelain all of the criteria of smile design principles ery of an esthetic result.9 mised (Figure 17 and Figure 18). restorations, a custom abutment and crown except that teeth Nos. 7 and 10 appeared To assure appropriate but minimal on the implant, gingival recontouring on dark and were lingualized (Figure 12). reduction, Luxatemp® Fluorescence pro- CASE THREE the right bicuspids, and a Zoom! power This appeared to be a perfect case for “prep- visionals (Zenith Dental, Englewood, NJ) A patient presented with a provisional bleaching on the mandibular teeth.12,13 less veneers” (feldspathic porcelain).7 It is were added to the facial surface of the restoration over a stock abutment that Correction of the crown shape and vol- important to note that if no preparation lingually positioned lateral incisors using she deemed unsightly because of the color ume was determined by the fabrication is performed, the emergence profile will the Gürel technique (Figure 14).10 In this and shape.

Load more