Esthetic Excellence

8/2/2019 Esthetic Excellence

1/32

Laura Kelly, CDTImmediate Past President and Accredited laboratory

technician, AACD

Betsy Bakeman, DDSAccredited Fellow and Chair, American Board of

Cosmetic Dentistry

M. Johnson Hagood, DDSAccredited dentist, AACD

Kenneth F. Hovden, DDSAccredited dentist, AACD

Nelson Rego, CDTAccredited laboratory technician, AACD

John Roberts, DDSAccredited dentist, AACD

Michelle Robinson WeberAccredited laboratory technician, AACD

A supplement to a Montage Media publication

Esthetic Excellence


2/32

The Benchmark

of esTheTicsLaura Kelly, CDT*

HE BENCHMARK OF EsTHETiCs

F

or several decades, the American Academy o Cosmetic Dentistry

(AACD) and its members have pursued higher standards in dental

care. The dentists and dental technicians comprising the Acad-

emys membership strive not only to enrich their personal understand-

ing o cosmetic dentistry and their individual skills, but also to provide

a new benchmark in quality and esthetics or their patients as well. For

continued proessional growth, these practitioners rely on the counsel o

their colleagues and additional training they receive at the yearly AACD

scientifc session.

Many AACD members elect to urther distinguish their talents by

seeking accredited status rom the Academy. Accredited members

o the AACD have successully completed a rigorous testing process

that involves written, oral, and clinical requirementsmost specifcally

the completion and documentation o specifc clinical cases. As shown

in the Supplement that ollows, these cases encompass a variety otreatment modalities and must meet quality standards and protocols

as defned by the American Board o Cosmetic Dentistry.

The American Board o Cosmetic Dentistry does not endorse any par-

ticular clinical technique or style, nor does it endorse particular products or

materials. It is acknowledged that Accreditation success is not dependent

on the technique or the materials used, but on the excellence o the fnal

result. The applicants eatured herein have utilized Ivoclar Vivadent adhe-

sive materials and ceramics to support them throughout the Accreditation

process. Ivoclar Vivadent has a longstanding history among the esthetic

dental community not just or the quality o its restorative solutions, but

also or its ocus on educating dentists and ceramists on their optimal use

during daily practice. Ivoclar Vivadents sponsorship o this Supplement isanother example o the companys interest in supporting dental proes-

sionals within the Academy and those aspiring to achieve Accreditation.

On behal o the many technicians and dentists who rely on Ivoclar

Vivadent or its leading role in educating dental proessionals, we thank

you or your support. Together we oer our congratulations to the

AACDs latest group o Accredited Members, and or their continued

pursuit o excellence in dentistry.

* Immediate Past President, and Accredited Member, American Academy of

Cosmetic Dentistry; President, LK Dental Studio, San Ramon, California.


3/32Table of ConTenTs 1

PREFACE: The Bechmark of EstheticsLaura Kelly, CDT

The Road to Success:America Academy of Cosmetic Detistry Accreditatio

Betsy Bakeman, DDS

Comprehesive Restoratio of Aterior Crow Legth adProportio Usig a Direct Resi Veeer Techique

Kenneth F. Hovden, DDS

Esthetic Ehacemet of the Maxillary Aterior RegioUsig a Feldspathic Porcelai System: Laboratory Protocol

Michelle Robinson Weber

Laboratory Procedures i the Esthetic Restoratioof Maxillary Lateral Icisors

Nelson Rego, CDT

Esthetic Ehacemet ad Pathologic Occlusio Usig Six

All-Ceramic Crow Restoratios

M. Johnson Hagood, DDS

Aterior Esthetic Restoratio Usig a Direct ResiVeeer Techique

John Roberts, DDS

i

03

05

09

17

21

25

TABLE OF COnTEnTS

Sponsored by an unrestricted educational grant provided by Ivoclar Vivadent


4/32


5/32

THE ROAD TO SUCCESS:Betsy Bakeman, DDS*

For practitioer wit a iteret i advacig teir educatio ad

ki i te area o etetic or cometic detitry, te America

Academy o Cometic Detitry (AACD) Accreditatio proce

provide a icomparabe ramework or growt, tudy, ad earig.

Te AACD Accreditatio proce i uique i tat it require detit

or tecicia to impemet wat tey ave eared ad to demotrate

a eve o profciecy a dictated by te America Board o Cometic

Detitry. Te amout o time ad eort eceary to attai te required

eve o profciecy varie baed o a idividua epoure to ad par-

ticipatio i advaced educatio, a we a i or er pre-eitig ciica

ki. Regarde o oe tartig poit, ucceuy acievig Accred-ited tatu i te AACD require time, dedicatio, ad true eort. By

competig ti proce, AACD Accredited member are abe to appy a

variety o etetic ki tat demotrate teir abiity to deiver optima

ora eatcare uig direct ad idirect retorative procedure.

Te Accreditatio tetig proce comprie tree part: a writte

eamiatio, ciica cae ubmiio, ad a ora eamiatio. Te

writte eamiatio tet oudatioa kowedge i cometic detitry

ad i admiitered at te AACD aua cietifc eio. Oce te

ciicia or tecicia pae te writte eamiatio, e or e a

fve year to uf te additioa requiremet.

Te ciica cae ubmiio ad evauatio orm te eart o te

tetig proce. Idividua demotrate, troug te ue o preop-erative ad potoperative potograpic documetatio, ciica ad

diagotic eceece i a pae o cometic detitry. Te protoco

dictate tat te cae tat are ubmitted oer a compreeive mi

o cometic treatmet outio tat kied detit ad tecicia

oud be abe to eecute we providig etetic detitry. Te fve

required cae type or ciicia are:

American Academy of Cosmetic Dentistry Accreditation

Bakeman 3


6/32

EsThETIC ExCEllEnCE

Case Type 1. Ti preetatio ivove

i or more idirect retoratio witi te

maiary arc, treatig at eat te icior

ad caie. Te key to deiverig a opti-

ma cae preetatio i i eurig tat

te ciicia abiity to create a ope,

workig, ad ucceu rapport wit te

aboratory tecicia i evideced rom

tart to fi.

Case Type 2. Ti cae ivove oe or

two idirect retoratio i te maiary

aterior regio treatig icior, ad te

adjacet teet mut ave o idirect re-

toratio. Te caege wit ti cae

type i i evauatig te ciicia abiity to

matc te atura urroudig detitio.

Case Type 3. I ti preetatio, te ci-

icia demotrate a abiity to deiver

etetic reut via a fed partia de-

ture (FPD) or impat-upported retora-

tio. Te FPD oud cotai at eat oe

potic tat repace a maiary icior or

caie. I a impat retoratio i paced,

it oud icude a root orm impat ito

te maiary aterior edetuou pace.

A radiograp mut ao be ubmitted to

ow te pace or aiig toot prior to

impat pacemet.

Case Type 4. Ti cae coit o a

aterior direct rei (Ca IV or diatema

coure) retoratio, i wic te detit

abiity to bed compoite rei wit teatura detitio i evauated.

Case Type 5. Ti cae ivove i or

more direct rei veeer, wit te ciicia

treatig at eat te maiary icior ad

caie. Cae Type 5 tet te detit abi-

ity to create a optima etetic reut uig

direct compoite rei materia.

Matery o te fve required ciica cae

type utimatey aow ciicia to provide

teir patiet wit a broad rage o treatmet

outio. laboratory tecicia mut com-pete te frt tree cae type wit te addi-

tio o uppemetary bec potograpy. Te

ora eamiatio compete te proce, aow-

ig ciicia to review teir cae wit a team

o Accreditatio Eamier, deed teir treat-

met, ad provide outio to a ypotetica

ciica cae.

I ummary, Accredited member ave

demotrated a commitmet to te art ad

ciece o deiverig detitry tat traced

te cutomary boudarie o our proeio.

Patiet ca be aured tat Accredited

AACD detit ad tecicia ave demo-

trated a ig eve o ki ad epertie i

providig a variety o treatmet outio a

tey reate to etetic detitry.

Cogratuatio to te 20 ewy Accredited

member wo were oored ti pat year

at te AACD Aua scietifc seio ed i

new Orea, louiiaa:

Duae h. Beer, DMD

Jorge R. Baco, DDs

Tim M. Bradtock-smit, BDs

steve h. Brooker, DDs

David s. Eom, DDs

Ricard W. Featertoe, DDs

Micae K. Fort, DDs

Taaz T. Goodjo, DDs

M. Joo hagood, DDs

Emi hawary, DDs

Keet F. hovde, DDs

Ted J. Murray, DDs

neo A. Rego, CDT

Jo C. Robert, DDs

Micee Y. Robio Weber

Troy Ae scmeddig, DDs

Jo W. simmo, IV, DMD

Jey C. su, DDs

Wiiam h. swearige, DDs

scott R. Werkamp, DDs

I ceebratig idividua acievemet, te

Academy ao ceebrate te tadard o

eceece tat Accreditatio repreet.

Te idividua oored remid u tat we

mut a determiedy recommit to educatio

ad te puruit o eceece. We mut work

togeter to cotiue to eevate te tadardor optima etetic, te tadard or erv-

ig te bet iteret o our patiet, ad

te tadard or maitaiig etic o te

iget order.

.

* AACD Accredited Fellow; Chair, American Board of Cos-

metic Dentistry; Private practice, Grand Rapids, Michigan.

THe ROaD TO SUCCeSS


7/32hoVDen 5

U Drct R Vr Tcqu

CompRehensiVe ResToRaTionof anTeRioR CRown LengTh

anD pRopoRTionKenneth F. Hovden, DDS*

Dental patients who request esthetic

enhancement or require restorative

care can oten be managed through

multiple treatment options, each with

its ideal indications. While direct com-

posite resins are oten overlooked as

viable treatment alternatives in com-

plex cases, resin materials can allowthe clinician to modiy tooth color,

width, length, shape, and guidance,

with minimal preparation. This case

depicts the use o a direct resin tech-

nique used to veneer nine teeth in the

anterior maxilla, with optimal esthet-

ics and unction.


8/32

EsthEtic ExcEllEncE

coMPrehensiVe restorAtion oF Anterior croWn Length

C

oemporary adeve dea e-

que eabe e a o eevey

repae e dered oo ade, o-

our, ad appearae. compoe re maer-

a ave ao mproved, aowg e ue-

u reorao o uo ad ee w

mma wear o e oppog deo; aura

ookg ee a ao be deveoped ug a

mped, mmay vave eque. Uke

mo proe ouo, oday ompo-

e maera (eg, 4 seao, ivoar Vvade,

Amer, nY) a be ued w predabe

reu o augme e eg oo ruure

w ay reverbe reu.1,2

C prtt

A 26-year-od mae pae preeed w ar-

e, type iii perodoa deae uve o

mupe 5-mm ad 6-mm poke, beedg

upo probg, ad eavy auu (Fgure 1

ad 2). care rk aeme wa odued

ad ormed e pae wa a oderabe

rk or are; e pae wa prerbed a a-

ome mou re (e, car-Free, Ora Bote

llc, Abay, OR) o redue are rk.

May o e poeror ee were o-reorabe ad requred erao. Mupe

ee ao requred dre reorao.3-6 Oe

ee a reque were ompeed,

wa eeary o purue e abrao o

dago mode ad urer poeror rea-

bao w e ue o mpa ad ed

proe. Eeay, e maary ae-

ror ee demoraed erproma are,

aa deaao w are, mapoo-

g, ad poor row wd-o-eg rao.

Trtt pl

te a reame pa oed o roo

pag a our quadra, oowed by

oroug ygee ruo ad mpeme-

ao o e are preveo program. no-

reorabe ee woud requre erao,

ad a dre re veeer prooo wa ed-

ued o reore ee #5(14) roug #13(25).

Reparao o e bua orrdor deey,

uee oo roao, ad mapooed

deo addo o reame o e area

o deaao ad are-ad-ore were

ao requred. Edodo erapy wa e-

eary or oo #15(27), oowed by a po

budup ad reorao w a u-overagerow. Ggva row egeg wa e-

eary e aeror egme o mprove e

eg wd-o-eg rao ad rae era

ue eve o be armoou w e e-

g eve o e maary rg aera or.

te eod pae o reame woud o

o abrao o mpa ct gude o dey

e poo o poeror mpa, or reao

o a urga gude, ad or mpa paeme

o repae ee #18(37) ad #19(36) pror o

er proe reorao.

Clcl prcdur

Premary mpreo were apured ad

mode were abraed. From ee mode,

a dea waup wa reaed baed o me

deg udamea. t wa aomped

w a eer waer ad de wa. A oe

mar wa e reaed o gude e dre

bodg eque.

Figure 1. Preoperave appearae demorae

ompromed ee ad uo bo e

maary ad madbuar rego.

Figure 2. Preoperave radograp evauao demorae erproma

boe o ad deay.


9/32hoVDen 7

te o ue wa r reooured ug

a Er:YAG aer oowg e admrao

o oa aeea. tue eve were mod-

ed o be armoou w oo #7(12). A

ue modao wa perormed or e

o ue oy ad ever eeded beow e

emeoeame juo. te aer-reaed

ue were aowed o ea or oe week.

sme deg wa baed upo e po-

o o e maary e era or, ad

ee #6(13) roug #8(11) were reaed a

e r reorave v (Fgure 3). Oe week

aer aer ue oourg, e dre veeer

prooo wa aed (Fgure 4 roug 7).

W puy a ad aa mare rom e

dago waup, area a requred eam-

eopay were deed o emae poe-

a ow roug. Area w deaao

ad are were removed, ad e ee weremro-eed o maa a mmay vave

preparao deg.

Oe ea oo wa prepared, e oe

mar wa ued o a e ompoe

budup proedure. te ee were eed

w a 35% popor ad maera or

30 eod, red or 30 eod, ad ar

dred. A deezg age wa apped or

30 eod o e de ad boed dry w

a mrobru. te bodg age (EtE, ivo-

ar Vvade, Amer, nY) wa e apped,

ar dred, ad ured.

W e puy mar pae, 4 seao

Bea Medum (ivoar Vvade, Amer,

nY) wa ued o rereae e gua ape

ad a edge o e oo. A A3.5 de-

ade wa e apped werever

de ruure were mg. A rb-

bo o ia cear (4 seao, ivoar Vva-

de, Amer, nY) wa e paed aroud

e de obe ad adjae o e a

edge o reae ome rauey e e-

ra ad aera or. ne, a A3 Eame

ade wa paed over e ggva rd

ad eaered o e mdde ad a

rd. te oo wa e broug o u o-

our w a Medum Vaue ade. Ea ayerwa ooured w abe brue dpped

modeg re ad ured or 20 eod. Fo-

owg e appao o a deoyg ouo

(e, Deo, Urade, sou Jorda, Ut), a a

ure wa perormed o ea oo or 40 e-

od pror o g ad pog.

A e ubeque v, e maary e

ae, aera or, ad era or ad

Figure 6. A rerao ord wa ued

e maary rg quadra, ad e dea-

ed oo ruure were prepared.

Figure 3. te maary aeror rego

wa edued or reorao ug a

dre ompoe re veeer prooo.

Figure 7. A oervave preparao

deg wa apped e maary

e quadra

Figure 4. Preoperave vew demo-

rae e preee o roaed aera -

or, mapooed ae, ad deay.

Figure 8. Faa vew o e ompeed

dre veeer. te madbuar ee

were edued or ubeque are.

Figure 5. Aoug e poeror ma-

dbuar deo requred erao,

uee agme wa ao pree.


10/32

EsthEtic ExcEllEncE

coMPrehensiVe restorAtion oF Anterior croWn Length

dre veeer paed ug e aoreme-

oed eque. Bo r premoar ad

bua deaao bu were pooed

we e ar, o aa re were paed

o oea e deaao. te ma-

ary rg eod premoar ao ad a dre

re veeer paed o overome bua

orrdor deey.

te pae reured or addoa v o

e-ue e age, ompee a pog,

ad oba deve poograp ad rado-

grap (Fgure 8 roug 11). trougou

e proedure, e mporae o proper ora

ygee wa reored.

Cclu

t ae demorae me mprovemeug dre re veeer ad oervave oo

modao. A e proedure progreed, e

pae uderwe o oy a ee raor-

mao bu ao a ora ea awakeg. h

ome ygee mproved dramaay, a dd

perepo o overa aa ee. te pae

wa very peaed w ew me ad a-

paed ompeo o e poeror prooo

order o reur e pae o orma uo.

Rrc

1. Peyo J. Dre reorao o aeror ee: Revewo e a eque ad ae preeao. PraProed Aee De 2002;14(3):203-210.

2. Era R. Aredao a ae repor: Dreveeer. J come De 2002;17(4):36-41.

3. Bak J. creag beauy w your ow wo ad: Amped approa or dre veeer. J come De2002;17(4):49-56.

4. Ruea c. Fudamea o Ee. cago, il:Queee Pubg; 1990.

5. Gode R. Ee Dery. 2d ed. hamo,lodo: B.c. Deker i; 1998.

6. Dawo P. Evauao, Dago, ad treame oOua Probem. 2d ed. s lou, MO: cV Moby

compay; 1989.

* Adjunct Assistant Proessor o Endodontics, Uni-

versity o the Pacifc School o Dentistry, San Fran-

cisco, Caliornia; Clinical Instructor, Hornbrook Group;

Faculty, IDEA; Director, Bay Area Aesthetic Masters

Hornbrook Group Study Club; private practice, Daly

City, Caliornia. Accredited member o the AACD.

Figure 9. Pooperave oua appear-

ae oowg dre ompoe re re-

orao o e maary aeror deo.

Figure 10. te poeror deo were

eraed pror o mpa paeme ad

proe reabao.

Figure 11. Pooperave vew o e

aeror rego oowg predabe reo-

rao w a dre re veeer prooo.

I use a eathering technique when applying the A34 Seasons Enamel shade over the incisal layer aroundthe dental lobes. This allows me to create a more naturalshade transition in the middle and incisal thirds.

Kenneth F. Hovden, DDS

CLiniCaL Tip


11/32robinson Weber 9

U fldtc prcl st:

Lbrtr prtcl

esTheTiC enhanCemenTof The maxiLLaRy

anTeRioR Region

Michelle Robinson Weber*

Patient confdence is oten dictated by

the esthetics o his or her smile. Dental

proessionals thus have a responsibil-

ity to ensure that any restorative treat-

ment given is o the highest possible

quality. The dental technicians role in

the restorative process is to provideesthetic restorations that blend in well

with the natural dentition. This pre-

sentation describes the use o a sys-

tematic laboratory abrication process

as means o delivering ull-coverage

crowns or seamless integration with

the patients natural dentition.


12/32

EsthEtic ExcEllEncE

0 esthetic enhAnceMent oF the MAXiLLArY Anterior region

Apae me a ave a ga

mpa o or er quay o e. Bo

proeoa ad peroa reaop

a be eer eaed or dmed by e

odo o oe ee. te a ad

dea ea ave e aby o mprove

a pae odee ad, ereore, over-

a we-beg by provdg a mea o orre

e eg, ade, uo, ad ape o o

oy e dvdua ee, bu a ey reae o

ea oer e ere me. i e aeror

maa, ee goa are drey fueed by

e aby o e reorave eam o aeve

a armoou rao bewee e aura

deo ad ee dea reorao. A

ow e preeao a oow, we a

ge oo or ee requred, aege

maged, a a proper ade ma w be

ra o pooperave ue.

C prtt

A mdde-aged emae pae preeed w

e dere o revaze er me. te aeror

deo ad bee wor over e year ad

evera daemaa were pree (Fgure 1).

Addoa oo eg wa dered by e

pae e aeror rego, ombed w

daema oure, rageg, ad we-

g. te pae ao epreed a preeree

a er me maa a aura appearae.

te ue eg o bo era or wa

raed appromaey 1 mm ug a 810-mo ue dode aer (eg, Odyey, ivoar

Vvade, Amer, nY). Due o e preee o

eg reorao, e premoar ee were

prepared or u-overage reorao. te

ae ad era or were redued ug

more oervave eque o aommodae

ree-quarer veeer. lay e aera or

were prepared or u-overage row o oe

e daemaa ad repae e eg om-

poe reorao. A oa were broke o

eure e eram ad oro over porea

ayerg erpromay ad a e embraure;

pooperavey woud dever a more ba-

aed me.

A mpreo o e prepared ee wa

made, ad e ee were provoazed.

te mpreoad a reaed dago

ormaowa ubequey oveyed o

e dea aboraory or ue rougou e

reorao abrao.

Lbrtr prtclA edpa porea (e, iPs ile, ivoar

Vvade, Amer, nY) wa eeed or ue

a reraory eque. te poograp

ad mode o e provoa reorao

were o be oey oowed or ape, eg,

ad uo (Fgure 2 ad 3). te a

ad ao requeed a oa e ee,

e e ade o e prepared deo wa

uorm ad g oor. Addoa orma-

o reeved rom e a uded a a

oo ade w a g oor varao or e

ae. Appromaey 1 mm o a ra-

uey ad medum urae eure were

ao requred.

Rrctr mdlte abrao o mode or ae bega

w e pourg o a mpreo ug

de oe (e, Yeow Prma Rok De soe,

Wp M, louve, KY). te mode, w

e eepo o e workg mode, were a

aowed o arde. ne, ey were rmmed,

Once the restorations are refned and ready to glaze, I like tosteam the porcelain to remove any debris, and then thin theUniversal Glaze Paste with a Glaze Medium using a smallstain brush to provide the best possible luster.

Michelle Robinson Weber

LaBoRaToRy Tip



ped a eeded, ad baed. te workg

mode wa e poured ug e ame de

oe ad a pre-dred bae pae (Zeer bae

pae, servo Dea, norbrook, il) w p

paed o e prepared mpreo. Oe e

maera ardeed, e mode wa removed

rom e mpreo. A ee oe wa

removed w a ae. te de were epa-

raed ug a damod d (#911h, Braeer

UsA, savaa, GA) ad rmmed w a #8

arbde bur. te mode were dupaed ad

e de were degaed pror o aruao

(srao, ivoar Vvade, Amer, nY) o e

aebow ad be.

prcl fbrctPror o budg ay par o e reorao, aa mar wa abraed rom e provoa

mode order o avod overbudg. Oe e

reraory de ad ooed rom burou, ey

were ready or a wa/oudao rg ug a

equa m o B1 ad A1 body porea o e

aa, a, ad oua urae o e de.

A Opa Ee 2 porea wa apped aroud

e marga area o reae e oa e

ee (Fgure 4). t ayer o porea were

paed o e waer-oaked de, e gy

apped o eure moo, eve overage o e

prepared area. te porea wa e oued

w ue paper o remove ay moure ad

paed o e porea urae (e, Programa

P100, ivoar Vvade, Amer, nY) or rg.

te de were red o 925c.

Oe rg wa ompee, e de were

aga oaked waer, e paed bak o

e dupag ray. Reerrg o e a

edge mar, e r budup wa perormed

ug a m o e ame B1 ad A1 porea.

t m wa bu up oo e a area o

orm e era obe. te premoar de

ruure wa bu up ad Oua Orage

porea wa apped o e era oa

area. Porea wa boed w a ue oremove ee moure. no odeg

wa perormed. A porea ke wa ued

o u roug e oa area o eparae

ea oo, ad e de were red aga o a

maurao emperaure o 915c. Oe oo,

e de were paed bak oo e dupa-

o ray ad oo e aruaor, e oed

o e a mar o very a e obe

Figure 1. Preoperave vew demo-

rae e preee o ee pag,

oo wear, doorao, ad or -

a row eg.

Figure 3. Oe e ee were prepared

ad mpreo raerred o e abora-

ory, a workg mode wa reaed o

eure deveopme o opma uo.

Figure 4. Porea budup wa om-

meed, ug e oe empae

o eabe pree reproduo o e

dered oour, eg, ad wd.

Figure 5. A ombao o B1 ad A1

porea (iPs ile, ivoar Vvade,

Amer, nY) wa ued o orm e er-

a obe pror o rg.

Figure 6. Evauao o e a budup

ad obe appearae oowg a

porea rg.

Figure 2. A dago mode w e

dered row eg ad ue oour

evdeed oowg aer reame.


14/32

EsthEtic ExcEllEncE

2 esthetic enhAnceMent oF the MAXiLLArY Anterior region

ad o bee over-bu ad were e or-

re poo (Fgure 5 ad 6).

te de were aga oaked waer o

aep e e porea appao. te

body porea m wa apped a wa prev-

ouy o ompeae or rkage. te gua

ape o ee #7 roug #10 were bu up

o reae a ava o w o appy e

era ee (Fgure 7). te de ru-

ure wa bu up o e ae a we a

e premoar ug e body porea m.

sa wa ued e era oa area o

e premoar o reae more dep. A u

were eparaed w a porea ke, e

erproma area were oued up, ad e

porea wa red aga o 915c.

te red budup wa paed oo e

dupao ray ad oo e aruaor, epaed aga e a mar o eure a

e a edge ad obe were orre. te

oour ad a edge o ee #7 roug

#10 were orreed w Opa Ee 1 ad

Opa Ee 2 porea (iPs ile, ivoar

Vvade, Amer, nY). te lg Mammeo

porea wa ued o eae e obe dea

ad reae g fker o era ara-

erzao. A ma amou o Amber wa ued

or addoa araerzao (Fgure 8). te

porea wa e red aga a 915c.

te ooed de were paed o e ray

ad e oour were evauaed ug e

a mar. A mro damod d wa ued

o remove a ma amou o ee pore-

a rom e mea ad da edge pror o

oug. Foowg a evauao o oor

ad ee (Fgure 9), e a oour wa

reaed, aerag Eame 1 ad Ee 1

ad 2 (iPs ile, ivoar Vvade, Amer,

nY) over e ere urae o e ee. te

gua ape were ompeed e ame

wayaga, keepg w e orm o e

mar w e eepo o ompeao or

rkage. A ma amou o neura Eame

wa beaded aro e a edge wa bru o reae ao w e ed

porea (Fgure 10). t bru eque

eabed e abrao o reed reorao

a requred mma oourg w a bur.

te ee were eparaed w a porea

bade, ad a ma amou o porea wa

added o e oa area. te porea wa

e red oe more.

Figure 10. Eame ee were added o

e gua ad aa urae, ad are

wa ake o ree e reorao ug

a bru eque.

Figure 11. Pooperave vew o e a,

gazed reorao. noe e oa

e ee ad aura rauey

aeved ug e reraory eque.

Figure 12. Pooperave appearae

demorae armoou egrao ad

a aura, eke appearae.

Figure 7. te gua-a ape o

ee #7 roug #10 were bu up o

aow ee era ee.

Figure 8. coour ad a edge

were orreed, ad a lg Mammeo

porea wa ued o reae fker o

era araerzao.

Figure 9. lg rauey ad oor

ee were areuy evauaed pror o

a oourg.



Cturte ooed reorao were ea red o

e mode dvduay, begg w ee

#8 ad #9 order o maa e orre

mde. te porea wa marked w mark-

g ape ad ay eavy oa area were

reeved w a damod bur. Ea reorao

wa paed e ray oe a a me, ad e

oa were adjued aordgy. i add-

o o ug aruag ape, ea reora-

o wa red w myar rp a we. te

adjae ee were removed ad paed o

e ray o very a oa aga. Fay, a

pee were red ogeer.

te ompee mode wa paed o e

aruaor, ad ay eeary adjume

were made or er reao. Proruve ad

ae moveme were ao eked, ad

a oourg wa aeved by ug a om-

bao o a #850 damod bur ad mrod

(Braeer UsA, savaa, GA). Fa mor-

poogy wa reed ug a fame-aped

damod bur ad perkymaa were reaed by

gy weepg e bur orzoay aro

e urae.

fl glzte reorao were red o 830c ad e

e o oo. A damod-mpregaed wee

wa ued o gy ree e gazed urae

ad area o e reorao a woud o-a e pae p ad reae aura wear.

Fay, a Robo bre bru ad a medum

porea pog pae were ued o brg

e porea o a medum uer.

te reorao were eam eaed ad

dveed ug ga bead a 80 p. Ay

remag porea aroud e marga

area were removed w e mpregaed

rubber wee pror o g o maer de.

Oe e reorao were eaed o e

maer de, e marg were eked

uder magao. te maer de were

e paed bak o e dupaor ray ad

a reorao were areuy paed; ma

adjume were made o e oa a

eeary. lay, e reorao were o

e od mode, a w me e marg,

oa, ad ouo were vered oe

more. A reorao were re-poed w

a bre bru ad pog pae o e

ay area a ad bee adjued (Fgure 11).

Pror o devery o e ae, e ago ur-

ae o e reorao were gy ad-

baed w 50 m aumum ode, e

eed or oe mue ug a eram ydro-

fuor porea e. tey were red w

waer, paed a eurazg ouo or

30 eod, oaked a up o aoo a

urao eaer or a addoa 5 mue,

ad ar dred. te ere ae wa e evau-

aed, paked or devery, ad emeed by

e a pror o oua adjume a

eeded (Fgure 12).

Cclu

By dgey oowg ea ep o e rea-

me pa, e reorave eam wa abe o

gay mprove e pae quay o

e. Durg abrao, areu aeo mube pad o dea o oor, oour, ad ape.

takg are o aommodae or porea

rkage ad ouay very , e abora-

ory ea may provde ee reora-

o a bed eamey w e aura

urroudg deo.

* Dental technician, CMR Dental Laboratory, Idaho Falls,

Idaho. Accredited member o the AACD.


16/32

EsthEtic ExcEllEncE

4 bALAncing siMPLicitY AnD VersAtiLitY

bALAncing siMPLicitY

anD VeRsaTiLiTy

After successful tooth replacement with an IPS

e.max bridge.

Before

Case 1Dr. Nick Addario, Chula Vista, CA.

Mr. Andre Michel, Dana Point, CA.

Case 2Dr. Michael R. Sesemann, Omaha, NE.

Mr. Lee Culp, Bradenton, FL.

After placement ofan implant-supported IPS

e.max crown restoration.

Implant components


17/32IPS E.max 15

With IPS e.max, dental professionals have a system for fabricating either lithium dis-

ilicate, high-strength glass-ceramic or zirconium oxide restorations. Its clinical perfor-

mance combines esthetics and strength for any region of the mouth, enabling clinicians

to provide their patients with beautiful, natural smiles. The ability of dental technicians

to achieve a predictable shade match in even challenging combination cases makes IPS

e.max a valuable treatment option for numerous AACD members and alumni.

Case 3Dr. Tom Trinkner, Columbia, SC.

Mr. Matt Roberts, Idaho Falls, ID.

After placement of IPS e.max lithium disilicate

and zirconia restorations.

Before

After esthetic replacement of gold intracoronal

restorations with IPS e.max inlay/onlay.

Before

Case 4Edward Lowe, Vancouver, BC.

Mr. Nelson Rego, Santa Fe Springs, CA.


18/32

EsthEtic ExcEllEncE

6 Anterior Aesthetic restorAtion Using A Direct resin Veneer techniqUe


19/32rego 17

i t ettc Rtrt mllr

Ltrl icr

LaBoRaToRypRoCeDURes

Nelson Rego, CDT*

While creating esthetic ull-mouth rehabilitations

can be an exhilarating experience, it is single-

tooth replacement that presents a greater technical

challengeand ultimately, rewardto the ceramist.

Successully blending a single restoration with the

adjacent tooth structures requires not only ones abil-ity to identiy the innate qualities o the natural tooth,

but then to imperceptibly mimic them in dental ceram-

ics. This situation presentation details a case where a

severely discolored lateral incisor was replaced with

a laminate veneer in order to provide a harmonious,

esthetic result.


20/32

EsthEtic ExcEllEncE

8 LAborAtorY ProceDUres in the esthetic restorAtion oF MAXiLLArY LAterAL incisors

Laboraory ea are aeged

o repae aura ee o a day

ba. Furer ompag e arge

o rereae e mupe ade ad uae

o aura ee va a porea medum e

eed o preey ma e eg deo

we reag oy oe or wo ee w e

ee rego. today dea maera ave

gve a ad ea a arge array o

opo or reorg e aeror ee; ee

ude eram maera a mm eame

bo wear reae ad appearae. t

ae preeao demorae e abora-

ory prooo ued or e reorao o ae-

ror aera or w ureored ee ur-

roudg e reorao.

C prtt

Clcl etA 38-year-od emae pae preeed w

a eg porea veeer o oo #7(12)

(Fgure 1). te pae ad weed er ee

ug a a-ome yem ad, we e wa

aed w e eg beaed reu,

a ade drepay wa evde w

e aeror deo. Aoug orodo

reame wa preeed a a opo o or-

re e pae oo agme, e pae

wa aed w e mor magme

pree. her prmary oer wa abou e

ade o e ge aera, ad a porea

amae veeer wa eeed o repar e

eg ee.

Oe e a-ome weg prooo wa

doued, ade ormao wa apured

ad raerred o e aboraory (Fgure 2

roug 4). te abume oo wa e pre-

pared w a amer marg, ad e prepara-

o wa poed o eure emao o ay

arp e age. te provoa reoraowa abraed ad eaed, ad mpreo

were orwarded o e aboraory o a-

ae abrao o e deve proe.

Lbrtr prtclA ca iV de oe wa poured ad aowed

o arde or 24 our. careu aeo wa

Figure 2. te pae wa rued o eae a-

ome weg order o eure aurae ade

daa or abrao o e porea veeer.

Figure 1. Preoperave vew demorae door-

ao oo #7 ad, ereore, a uee ade

ma e aeror rego.

Figure 4. coer evauao o e doored aera

or demoraed e ereme ade varao

evde a ge oo.

Figure 3. te eram wa aeged o rereae

rauey ad uer o e aura deo ug

a predabe eque ad maera prooo.


21/32rego 19

pad o e waer-powder rao order o

eure proper epao. te workg mod-

e were abraed ad moued o a ar-

uaor; e approved provoa reorao

were ao moued o e oppog mode.

A mar wa reaed ad ued o evauae

e aa ad proma reduo. te de

were areuy rmmed, ad a uderu

were boked ou w a uderu wa

maera. A u-oour waup wa e re-

aed (Fgure 5). A me, e oa

were waed o pae, ad e marg

were eaed w a mma rkage marg

wa (Fgure 6).

te waed amae wa prued ad

veed ug e peed pre eque,

ad preed iPs Empre Ee (ivo-ar Vvade, Amer, nY), ug a

EOc-1 igo (Fgure 7 ad 8). t go

wa eeed beaue o opa proper-

e ad g opay, w woud oea

e uderyg ade o e prepared oo

ruure. Oe e amae wa ooed

ad dveed, wa evauaed or ad

ayerg ommeed.

prcl Lr prcdurFoowg areu evauao o e dga

ade map ad preoperave poograp, e

porea budup wa u bak o aow e

auor o reae e may-aeed uae

a woud be requred o eure a aura-

ookg egrao. A oudao bake wa

readed w a ma amou o a ad gaze

pae, ad red a 770c. te amae wa

ayered w ia We ad Bamboo pow-

der (iPs Empre, ivoar Vvade, Amer,

nY) o reae e ee dpero o oor

a were pree e aura deo, ad

red a 840c. te amae wa eked w

e mar o eure a e ee were

e proper poo, ad a a ayer o Mt

a wa added o reae e raueya wa o eary demoraed by e au-

ra deo.

evlut, Ctur, d stte amae veeer wa emporary

emeed o e oe de ug syemp.k

(ivoar Vvade, Amer, nY) o aae

Figure 8. te amae veeer wa bu o oour

o e workg mode.

Figure 6. te preparao wa evauaed ad

boked ou a eeded.

Figure 5. te dered oo oour wa waed up

o e workg mode o eure proper wd-o-

eg rao pror o porea ayerg.

Figure 7. te a ubak proedure wa

aed o eure deveopme o ee

a rauey.


22/32

EsthEtic ExcEllEncE

0 LABORATORY PROCEDURES IN THE ESTHETIC RESTORATION OF MAXILLARY LATERAL INCISORS

a oourg. Varou damod ad rub-

ber wee were ued o provde a ee

urae uer, w are ake o e refe-

ve ad defeve area. te mar o e

approved provoa reorao wa ued o

eure a e a oour o e deve

reorao oey maed oe ommu-

aed by e emporary. te amae wa

gy aed ad baked oe. te a po

wa aomped ug a o bre bru

ad pae o aeve e prerbed go.

te reorao wa reured o e a,

were wa peed or ad ade o

e mode. te provoa wa e removed

ad e preparao wa eaed w or-

ede ad red. A re eme maera

(Varok Veeer, ivoar Vvade, Amer,nY) wa apped o e era urae o e

amae. te vaue adg o eme

wa a bee mag e ge-oo re-

orao o e adjae deo. te veeer

wa pooed, ee eme wa removed,

ad e reorao wa po poymerzed w

a 2-mm akg p. Ouo wa vered,

adjume made a eeary, ad a pore-

a pog k wa ued o reder e a

appearae o e reorao oowg de-

ve poymerzao (Fgure 9 ad 10).

Concuson

Mag a ge amae veeer o a pae

eg deo a ead o a g eve o a-

ao, e ae e aboraory e-

a aeged o reae a reorao a

bed mperepby w e aura deo.

A preed eram wa eeed aordgy,

baed o e go aby o dever opmaopay o mak e uderyg ubruure,

w a aura uer ad a rauey.

* Laboratory Technician, Santa Fe Springs, California.

Accredited member of the AACD.

Using a Sil-Tech matrix, I can inject wax into the prepa-

ration models and veriy i sufcient reduction is present

prior to beginning the abrication process, reducing the

need or remakes and eliminating potential error.

Nelson Rego, CDT

laBORaTORY Tip

Figure 10. noe e armoou egrao ad

aura-ookg ade ma aeved.

Figure 9. Pooperave aera vew o e deve

reorao oowg eme eaup.


23/32hAgooD 21

U s all-Crc Cr Rtrt

esTheTiCenhanCemenTanD paThoLogiCoCCLUsion

M. Johnson Hagood, DDS*

All-ceramic restorations such as IPS

Empress (Ivoclar Vivadent, Amherst,

NY) enable clinicians to predictably

and successully address their patients

increasing esthetic expectations. The

ollowing presentation demonstrates

a clinical protocol used to place IPSEmpress restorations in a patient

with compromised anterior esthetics

and wear. The provisional restora-

tions served as a trial therapy that

enabled the clinician to resolve the

esthetic expectations o the patient as

well as the occlusal concerns present.


24/32

EsthEtic ExcEllEncE

2 esthetic enhAnceMent AnD PAthoLogic occLUsion

Se e me o er roduo o e

dea dury ad proeoa, iPs

Empre (ivoar Vvade, Amer, nY)

a-eram reorao ave oered a ew

dmeo aeror reorave dery.

We provdg ee w opa ara-

er mar o oo eame, iPs Empre

row are ompoed o a omogeeou

eue-baed eram, w aer g

ke a aura oo ad eure a ee re-

orao bed w e adjae deo.

Reorao abraed iPs Empre mae-

ra eb e-ke rauey a we. i e

ae a oow, iPs Empre u-overage

row w be ued o mprove e appear-

ae o e pae me we reorg er

o paoog ouo.

C prtt

A 30-year-od emae pae preeed or

ee eaeme o er maary ad

madbuar deo (Fgure 1 ad 2). c-

a eamao reveaed e preee o a

PFM row o oo #9(21), daemaa e

maary ar, ad g o moderae wear o

e a urae o e madbuar or

(Fgure 3 ad 4). te pae wa ee-

e perodoa ea. te pae keea

reaop ad a ca iii edey ad e

madbuar or were reroed. terewere o abe odg oa bewee e

ower a edge ad gua urae o

e maary or.

te oao o e wearpredomay o

e aa urae o e madbuar or

wa dave o oo o ourrg durg

uoa moveme o e madbe. tra

erapy ad evauao woud u be ee-

ary o deerme oua orreo woud

reove e paer o wear o ee ee.

te ca iii keea edey ombed

w e oo-ar drepay o e ma-

ary ar reaed a pa o oure a ge-

eraed eeve roa ore bewee e

gua urae o e maary or ad

e oaa urae o e madbuar -

or. A oervave approa o reame

woud uze orodo erapy o aae

a ee oure pa o mamum eru-

pao a dd o reae premaure oadg o

e ee. however, e pae, duy ormed,

deed orodo reame. A reorave

opo a woud erve o addre bo e

uoa ad ee oer voved por-

ea reorao o e maary aeror

ee. A ee pa o oure o mamum

erupao woud be aaed by oow-

g e gua urae o e aeror ee

o aommodae e pae madbuar -

or durg uo. A eodary uoa

goa o reame woud be o reae abe

er op o a ee.

Trtt squc

A dago workup wa abraed; wa o-

rmed a bo e ee deee ad

oua probem oud be reoved roug

e paeme o u-overage reorao

o ee #6(13) roug #11(23), ad oua

equbrao. iPs Empre wa eeed a ereorave maera o oe, o oy or

ee quae bu or ow wear poea.

te provoa reorao woud be ued a

a empae or dreg reame ouome

eeay, poeay, ad uoay.

A vauum-ormed empae wa orued

o e dago a or ue a a reduo

gude durg preparao ad or abrao o

e provoa reorao. A oua de

wa ao abraed o ad pove eag o

Figure 1. Preoperave vew o daemaa

ad a edge poo o e maary

aeror ee, w reaed darmoy.

Figure 2. We e ggva areure

wa ymmer, e pae me wa

o eeay peag.

Figure 3. Oua vew o e maary

ar preoperavey reveaed e PFM

row o e maary e era or.


25/32hAgooD 23

e empae o a workg mode durg d-

re abrao o e provoa reorao.

tee #6 roug #11 were prepared o-

veoay, eep a mma oo ru-

ure wa redued e guum area ad

gy more reduo wa perormed o

e a wo-rd o e gua urae

order o oow em ad u beer aom-

modae e eveope o uo.

te row o oo #9 wa r removed, ad

e gro reduo o e oer preparao

wa perormed w damod bur. Rerao

ord wa paed ea uu, eavg 0.2 mm

o 0.5 mm o oo ruure vbe bewee

e marg ad e ord. te preparao were

e reed w e damod bur ued

a md-peed adpee. Foowg pog o

e preparao o emae ay urae rregu-are, agae mpreo were made o e

maary ar ad mmedaey poured w a-

eg dea paer.

idre provoa reorao were pro-

eed ary, rmmed, ad red o per-

m adjume o ouo. Equbrao wa

azed ad uded e eabme o

approprae aeror gudae. te provoa

reorao wa e eparaed o dvdua

u ad poed w a Robo bre bru.

te provoa reorao were emeed

ad e a mpreo were ake e o-

owg week (Fgure 5).

A e a mpreo appome, e

pae provded eedbak w regard o

e ade, oour, poe, omor, ad

ee o e provoa reorao. t

ormao wa oveyed o e dea abo-

raory o ad e abrao o e deve

reorao. A agae mpreo o e

maary ar w e eaed provoa re-

orao wa e ake; woud be poured

oe ad moued aga e workg

mode o a aruaor: 1) o gude e opma

ouo o e provoa reorao ad 2)

o ad e aboraory ea predaby

reprodug e dered ouo, oour,

ad a edge poo e deve reo-rao. Foowg e ompeo o a mpre-

o makg, e provoa reorao were

reemeed ad e pae wa eued.

Lbrtr itruct

A work order aompaed by a ee

ek, oor mappg, preoperave ad

provoa mage, a o e dago

Figure 5. te provoa reorao eabed e

pae o provde eedbak o ee, , u-

o, ad poe.

Figure 4. te PFM row o oo #9(21) rered

aura g ramo aroud e ggva marg.

Figure 6. Vew o e iPs Empre

a-eram row eaed o e mode

pror o ry ad emeao.

Figure 7. Pog up ad po were

ued or a pog, ad e reora-

o a uer wa reaed.

Figure 8. Oua vew o e iPs

Empre row pooperavey. Mma

oua adjume wa eeary.


26/32

EsthEtic ExcEllEncE

4 esthetic enhAnceMent AnD PAthoLogic occLUsion

workup, ad provoa reorao were e

o e dea aboraory. tee daa woud be

eea eurg e dered reu w

e iPs Empre row.

f

te row were peed upo er reur

rom e dea aboraory ad were we-adaped

o e mode (Fgure 6). te aa de abraed

e aboraory aga a moued mode o e

provoa reorao preey aga e

aa oour o e deve a-eram reo-

rao. te era urae o e iPs Empre

row ad a uorm roed appearae da-

ve o we-eed urae.

A e devery appome, e paewa aeezed, e provoa reorao

were removed, ad e ee were eaed.

te row were red w Varok ii try-

i pae (ivoar Vvade, Amer, nY). te

pae wa gve e opporuy o ae

e reorao ad e approprae eme

ade (e, rapare) wa deermed.

te row were e eaed ad eed

w 37.5% popor ad ge e o or

oe mue ad e red. t proe

removed ay urae oamao ad ad-

ed e porea urae, w reaed eeay o a ae oupg age. A rey

med ae oupg age wa apped o-

owg dryg order o reae e bod

reg bewee porea ad re eme

ad o dereae mroeakage.

A ee o be boded were eaed ad

red, ad a rerao ord wa paed ea

uu o eure a dry, uoamaed ed.

te ee were eed w 37.5% popor

ad ge or 15 eod, red, ad e we. A

weg age (eg, tubud Red, Goba De-

a, Bemore, nY) wa apped o we ad d-

e e eed urae. De prmer were

med, ad ve o eve oa were apped o

ea preparao. Oe uy dred, e prepa-

rao were g ured or 30 eod per

urae. Pre-Bod re (Bo, saumburg,

il) wa apped o e preparao. trapar-

e-aded dua-ure eme (eg, Varok ii,

ivoar Vvade, Amer, nY) wa med ad

paed ea row. te row were eaed

ad ea wa po-ured e eer aa

urae w a 3-mm urg p.

Ee eme wa brued ad foed

away, ad a urg wa aomped w

60 eod per urae or ea oo. Fur-

er eme remova wa aomped uga h6/h7 aer ad Bard Parker #12 bade.

te erva ad erproma urae were

ed ug damod g bur ad

arbde g bur w a ar-waer m.

A marg ad oo urae were areuy

peed or overag ad rouge ad

were e poed (Fgure 7 roug 10).

Addoa reame woud o o mor

reorave are, roue eamao ad

propya, ad moorg o oo wear.

Cclu

te ee reu were very ayg.

By muaeouy addreg e pae

ee ad uoa oer, a ueu

og-erm progo oud be eured.

* Private practice, Vero Beach, Florida. Accredited mem-

ber o the AACD.

Figure 10. Vew o e pae me oowg

reame demorae mproved proporo ad

armoy w er p.

Figure 9. Pooperave vew o e eaed

ee aeved roug e iPs Empre row

ad er egrao.


27/32roberts 25

U Drct R Vr Tcqu

anTeRioResTheTiC

ResToRaTion

By challenging clinicians to deliver

esthetic restorations using a vari-

ety o restorative materials, orward-

thinking dental proessionals are

exposed to an expanded armamen-

tarium. O the case types required or

accreditation, the delivery o natural-

looking direct resin veneers in theanterior region represents a level o

mastery dierent rom any other type

o skill demonstrated in the opera-

tory. This presentation demonstrates

the use o composite resins to create

natural, lielike results using a direct

chairside technique.

John Roberts, DDS*


28/326 Anterior esthetic restorAtion Using A Direct resin Veneer techniqUe

EsthEtic ExcEllEncE

Ee dery demad a era

eve o maery we ug a varey o

reorave maera order o oba

e dered a reu. sk preparao

deg ad emeao o porea veeer

aoe are o e oy quaao o a good

ome de. i addo o e maery

o dre porea reorao, ompo-

e epere rema a eeary k e

armamearum. Very ew de deveop e

k ad e ar o e dre ompoe e-

que or e purpoe o veeerg or more

aeror ee. For a majory o de, more

predabe, ee reu a be obaed

eaer ad aer w porea reorao

(eg, iPs Empre or iPs e.ma, ivoar Vva-

de, Amer, nY). We ee reame

ouo oe a or e ue o dre reo-

rao, ere are eray dao or dre

prooo. tee may ude (bu are o m-

ed o) addreg ee oer youg

pae, reame o pae wo w o

avod aggreve oo preparao, or pae

eed o raoa maera durg mud-

pary prooo. Uderadg ompoe

re ad e aoaed ayerg eque

we eoug o bok ou ad deveop o-

e ade, rauey, ad araerzao

w eray provde a opporuy o reae

auray udeeabe reorao a a aer-ave o porea veeer.

C prtt

A 32-year-od emae pae preeed or me

eaeme (Fgure 1). A a eamao

w eeary radograp ad a proe-

oa eag daed a o o or ard

ue paoogy were evde. Aoug e

pae ad prevouy udergoe orodo

reame (e, ivag, Ag teooge,

saa cara, cA) addo o ee row

paeme, g, ad roue are, ca i

ouo ad ca iii keea edee

remaed evde (Fgure 2). Mma, ay,

wear paer eed e eame. Fuo-

ay, aaory gudae wa evde durg

rg, e, ad proruve euro. no ba-

ag or workg ereree were oed

e poeror rego.1,2 no ory or ompa

o emporomadbuar dorder, pa, poppg

or rep upo mamum opeg, or aera

or proruve euro were oed (Fgure 3).

Faa ymmery wa evde, w o mde

. A md a wa pree o e e de,

w ow ue e ggva areure.

sor era ad aera or reued a

revered me e ad poor ee propor-

o (Fgure 4). te bua orrdor appeared

aaory (Fgure 5). te pae dd o ee

omorabe w e we ad brow po

vbe o e aeror deo, ad dered

greaer a eg, mproved poe,

ad eaed ee.

te pae perodoa ea wa ee-

e. too #13(25) wa reored w a pro-voa row ad requred repaeme

w a deve porea reorao. Ade-

quae ompoe reorao were pree

o ee #2(17) roug #5(14), ad #9(21),

#12(24), #15(27), #18(37) roug #23(32),

ad #26(42) roug #31(47). tee #1(18),

#16(28), #17(38), ad #32(48) were mg.

Figure 2. Preoperave appearae o e pae

me reveaed aeror ag ad uee

a araerzao.

Figure 1. Preoperave appearae demorae

e preee o ggva deay ad or a

row eg.


29/32roberts 27

Mor ggva ue orreo woud ao

be requred o mprove e a.3

Trtt pl

Aer mupe reame opo were d-

ued w e pae, dre veeer were

eeed o reore ee #5 roug #12 o

aer e me e ad e ade. too #13wa ao edued or row repaeme.

te oowg ep woud be oowed e

reame pa:

1) Continued periodontal maintenance and

good home care was expected, as it was

already habit or this patient.

2) Teeth #5 through #12 would be prepared

or veneers or veneer onlays.

3) A hybrid composite would be placed as

a base or the dentin shade and strength

in the fnal result.

4) Because the dentin structures were more

opaque and contained a more saturated

chroma, the use o a layered restorative

technique with calibrated translucencies

was selected to promote exceptionalesthetics and an accurate shade match.

5) An enamel-shaded microfll would be

placed over the dentin layer to be pol-

ished to a natural luster.

6) Maintenance o unctional occlusion would

ensure that the new composite veneers

would last in the new length and shape.

Figure 3. Foowg orodo reame, mproved

aera ad proruve gudae proeed aga

oua ereree.

Figure 4. te poo o e up p o e pre-

moar wa oger a e ae poo durg

preoperave evauao.

When patients present with dark underlying structures, aspecialty dentin shade (eg, B1 Dentin, 4 Seasons, IvoclarVivadent, Amherst, NY) should be placed on the cervicalaspect and tapered towards the incisal edge to create thedesired body shade, while adding strength to the underly-ing incisal length. Enamel Eects shades (White and Blue)can then be used to develop internal characterizations.

John Roberts, DDS

CLiniCaL Tip


30/328 Anterior esthetic restorAtion Using A Direct resin Veneer techniqUe

EsthEtic ExcEllEncE

Figure 6. Pooperave vew. noe e mproved

a row eg, oo ape, ad oour.

Figure 5. Maary oua vew o u, rouded,

we-deed a edge.

Rtrtv squc

Duo regardg oo eg ad e

remova o e brow po were o prmary

mporae beaue ee were, eeay,

e pae prmary oer. Ea oo

wa prepared ad rebu dvduay o a

oo orm ad poo woud o be o

(Fgure 6). te oo preparao deg wa

maaed a mpe maer, w marg

maaed upraggvay, ad e a

rd o ea oo prepared more aggre-

vey o aow pae or e deveopme

o a ade ad rauey. care wa

ake o eed e preparao o e

erproma area ar eoug o emaeerproma adowg.4

Foowg rubber dam oao, a ear pa-

rp wa paed bewee ea prepara-

o o maa opma erproma o-

a. Ug e oa-e eque, e

ee were eed w a 35% popor

ad maera or 15 eod ad red or-

ougy. A mrobru wa ued o aborb e

ee waer o e bodg urae, ad

a adeve maera (e, EtE, ivoar Vva-

de, Amer, nY) wa geerouy agaed

o e preparao or 20 eod, e ar

dred o evaporae ay aoo arrer e

bodg age.5 t ayer wa g ured or

20 eod per oo.

sade B1 De (e, 4 seao, ivoar

Vvade, Amer, nY) wa paed o e

erva ape ad apered oward e

a edge o eab e body oor ad

o provde reg o e addo a

eg.6 t ao eped emae a rao

oor bewee e de body o e pre-

pared oo ad e dered eg. t ayerbeame e uoa urae o e gua

ape. Deveopmea obe were ube-

quey ormed ayer ad e aed.

iera araerzao were e added o

gve warm ad ep dereae e aura

edey o ee o beome oo gray we

reaed brge. trauey wa

ed aog e a edge o eourage


31/32roberts 29

Figure 8. Pooperave vew ow reaed

a row eg ad eaed ee.

Figure 7. ia gudae ad eurve move-

me were ao mproved pooperavey.

reogo o e uderg araer

oor. te ao ee wa ormed by beve-

g bak e a edge a e proper age

o reae a reraed e o g. severa ay-

er o e a re ayer were removed ad

repaed a aemp o reae proper oo

oour (Fgure 7). cae gudae wa e

deveoped o e gua ape.7 te Be-

e wa dued w md preure o

e baag de o e madbe o eure

a baag ad workg ereree were

eared.8 Proruve ouo wa vered

pror o deve g ad pog.

ierproma re wa removed w

g rp ad e-fued arbde buruder opou waer rrgao. Aoug e

aa urae were poed ug dk w

varyg gr, are wa ake o o remove a

urae eure reaed durg paeme o

e eame ayer o ompoe re.9

Cclu

Oe, e rebudg o a ere aeror oo

ompoe eeary e ed o de-

ry or mproved ommuao w eeram. te a aby o roug ou

e dered a reu or a porea veeer

ae ompoe pror o preparao a va

k or ay praoer a epe o ee

ee. Uderadg e opa propere

o ompoe re ao beome madaory

we e a makg dark, udery-

g oo ruure or aempg o reae

uormy oor o e preparao or a

porea veeer ae.

Rrc

1. Okeo JP. Maageme o temporomadbuar D-

order ad Ouo. Four Edo. s. lou, MO:

Moby; 1998.

2. Dawo PE. Evauao, Dago, ad treame o

Oua Probem. seod Edo. s. lou, MO:

Moby; 1989.

3. ce GJ, Pau A. Ee o Aeror Fed Proo-

do. caro sream, il: Queee Pubg; 1994.

4. Beage JR. surga reoruo o e erde-

a papa: cae repor. i J Perodo Re De

1992;12(2):145-151.

5. heyma hO, Baye sc. curre oep de

bodg: Foug o dea adeo aor. J Am

De Ao 1993;124(5):26-36.

6. Aber hF. too coored Reorave. 7 ed. ham-

o, Oaro: Bc Deker, i, Ao Book Dvo;

1985.

7. Ma A, ca c, Mrae R. ifuee o group u-

o ad ae gudae o eeromyograp av-

y o eevaor mue. J Proe De 1987;57(4):

494-500.8. Ruea cR. Fudamea o Ee. caro

sream, il: Queee Pubg; 1990.

9. Mer MB, caeao iR. Reay. houo, tx: Reay

Pubg; 2001.

* Private practice, Idaho Falls, Idaho. Accredited member

o the AACD.


32/32

EsthEtic ExcEllEncE

Esthetic Excellence

Documents