Dentaltown July 2013 - (Page 140)

case presentation feature by Luke S. Kahng, CDT Case courtesy of Joseph L. Caruso, DDS, MS In a six-unit anterior case it is always essential to have excellent communication between the patient, the dentist and the lab. In order to get the most predictable design possible, it is best to have the patient’s pre-op and post-op photos e-mailed to the laboratory so that the technician can work with the dentist and get the results he is expecting. It is important to have this communication tool, especially for tissue design, size of teeth and length of incisal edge position, but also for color selection. Most dentists work with a shade tab that contains two tones, which makes it hard to communicate exactly what the patient is looking for. And unless the patient is an artist, he will probably not recognize exactly what he wants in his restorations. As background regarding our case study patient, the mandibular anterior teeth had a lot of stain interproximally. The patient and the clinician discussed what to do to accomplish natural looking aesthetics in the final restoration. From the lab’s perspective, the technician requested pre-op photos in a rest, retracted and smile view. He also asked for a side view and emergence profile. He noted that between the canines and premolar, the issue of concern was color and the patient wanted better overall aesthetics. He decided on an A2 base color with mamelon and translucency application in order to create bright, high value. Gingival Fig. 1: Retracted view 140 JULY 2013 » dentaltown.com Fig. 2: Prepped teeth enamel color was not discussed at that point but it was decided that the first step would be to cosmetically correct the maxillary teeth and work on the mandibular anterior dentition in the future. The lab procedures were discussed and the process for delivering predictable results was explained. Also of significance to the patient and clinician was the final analysis of color and shape for the teeth. Case Study The clinician sent the case for evaluation and the technician offered his viewpoint based on what he saw in the photos (Fig.1). Treatment indicated was on the upper anterior teeth. There was discoloration and stain on 7, 8, 9 and 10 with white calcification on the mandibular dentition. The temporaries would be created using A1 and particulars about color would be discussed in the future. Regarding shape and contour, in the impression it was obvious that numbers 8 and 9 were shorter than 10. The incisal area length was to be increased 2-3mm and the zigzag gap between 8 and 9 was noted as well. Buccal, mesial and distal angulation would be created to be more outward in appearance and a deep champfer prep all around was recommended. Because of the patient’s occlusion, zirconia restorations were also recommended in order to eliminate fractures. The prepared teeth clearly show excellent margin design (Fig. 2). The lab created a wax-up and a stent (Fig. 3) which was sent to Fig. 3: Lab created wax and stent for temporaries http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown July 2013

Dentaltown.com Highlights
Howard Speaks: Quit Rambling On
Professional Courtesy: New Patients with Baggage
Second Opinion: Radiation Minimization – “Are We There Yet?”
Is Anyone Really Cementing e.max with RMGI?
Please Critique My “Breakaway” Office Design
Surely People Don’t Die from Tooth Decay?
Townie Choice Awards Preview: Dentistry’s Official Gear Guide
Corporate Profile: Gendex
What’s On Your Tray? Endodontics
Product Profile: Synergy
Do-it-Yourself Finance, Part VIII: It’s Retirement Time! How Do I Get My Money?
Dental Education by Circuit Training
Everyday Dentistry with CAD/CAM and Lithium Disilicate
Ad Index
Maximizing Anterior Design for Predictable Results in a Six-unit Anterior Makeover
In This Issue: Dental Hygiene Diagnosis
Perio Reports
Continuing Education Periodontal Probes: An Overview of History, Evolution and Clinical Technique
Dentally Incorrect

Dentaltown July 2013