41994_Australasian_Dentist_100_EMAG

CATEGORY LINICAL

A step-by-step approach to aesthetic excellence: Every detail matters

By Adamo E. Notarantonio, DDS

Abstract: Social media has ooded the Internet with beautiful ‘before and after’ photographs of porcelain restorations. While these images can help promote the bene ts of cosmetic dentistry, one of the problems this can lead to is patients mistakenly assuming that such restorations are simple to achieve. ey may fail to realize that multiple steps need to be taken to attain such aesthetic results, with each step requiringmeticulous attention to detail. What some patients may not appreciate is the precision that goes into every step and which is critical to achieving long-term success. From preparation design and material choice, to selecting the correct bonding protocol and cements, no steps in the restorative process can be overlooked or deemed less important than others. e case presented describes a smile rehabilitation with proper isolation and cementation protocols. In today’s world where so much is dictated by speed, the importance of precision may tend to get overlooked. Modern technology allows almost everything to be done at a pace that seemed impossible in the past. is mindset has carried over into clinical dentistry, and in some instances this can be a positive, but in others itmayprove tobe troublesome. In the author’s view, one of the areas this can be problematic is when cementing porcelain restorations. To ensure the success of these restorations, proper isolation, chemical treatment of the restorations and dental tissues, and proper bonding protocols and techniques are crucial. Clinicians must understand that no step can be overlooked, and every step should be carried out with the utmost precision and accuracy. Case presentation e 36-year-old patient, a dentist herself, presented to the author’s o ce for a cosmetic consult. She was unhappy with the shapes and colour of her existing teeth, as well as multiple older resin restorations that were evident on her teeth (Figure 1 and Figure 2). After a thorough diagnosis and treatment planning in the periodontal, biomechanical, functional, and dentofacial aspects, a decision was made to move forward with 10 maxillary porcelain restorations.

Provisionals e rst appointment comprised a full diagnostic photograph series, digital scans (iTero®, Align Technology, Inc., itero. com), and a facebow transfer (Kois Dentofacial Analyzer, Panodent, panodent.com). e scans, photographs, and speci c instructions for the wax-up were sent to the ceramist at the dental laboratory for fabrication of a diagnostic wax-up. A detailed conversation between the clinician and patient revealed the exact

parameters she was looking for, and these were communicated through photographs to the ceramist (Figure 3). A diagnostic wax-up was returned from the laboratory (Figure 4). A silicone matrix was fabricated from the wax-up in order to create the provisional restorations. Following the preparations and necessary impressions, a provisional was fabricated via the existing wax-up (InstaTemp® Max, Sterngold, sterngold. com). Because patients undergoing this

Fig 2. Preoperative upper arch, retracted view with black contraster

Fig 1. Full smile, preoperative

Fig 4. Completed diagnostic wax-up on printed model

Fig 3. Images with lines drawn and verbiage to communicate changes to the laboratory technician for diagnostic wax-up

Fig 6. Final restorations on models in three different views

Fig 5. Provisionals 24-48 hours after preparation appointment

Fig 8. Final restorations on models in three different views

Fig 7. Final restorations on models in three different views

56 AUSTRALASIAN DENTIST