cosmetic dentistry - beauty & science

12 I I special topic _ minimally invasive cosmetic dentistry jacent opposing teeth to a normal and func- tional form is achieved in this step.53 _Finishing: This is a finishing process to estab- lish an even, well-adapted junction between the tooth surface and the restorations. _Aesthetic touch-up: Necessary minor adjust- ments to achieve natural surface details through texture, grooves, pits and other special surface effects. _Polishing: This step entails smoothing restora- tions to an enamel-like lustre. For clinical con- venience, this process can be further divided into three steps: a) pre-polishing: removing the remaining sur- face scratches from the aesthetic touch-up process; b) polishing: achieving blemish-free and smooth surfaces with no visible scratches; c) super polishing: creating enamel-like lustre or gloss. Aesthetic-finishing clinical facts are shown in Figure 15. _Finishing evaluation Post-operative clinical evaluation is one of the fundamental requirements of the keep in touchprincipleoftheMiCDtreatmentprotocol.1 Generally one week after the case finishing, the case should be re-evaluated in terms of health, comfort and aesthetics through clinical exami- nation, digital images and other necessary guid- ing tools. The end-result of force finishing should be re-confirmed before final case doc- umentation. _MiCD customised case-finishing protocol Based on the patient’s aesthetic wishes and level of sensitivity towards the occlusal force components (tooth-contact forces and timing sequences), MCCF can be divided into three clinical types: _Type I: In cases in which forces are not part of creating the aesthetic case changes, as well as cases of non-load-bearing anterior and poste- rior restorations, tooth-whitening procedures, reductive and additive contouring (both the teeth and gingival tissues) if correction does not alter the existing occlusal scheme, these cases are generally finished according to the type I MCCF protocol (Table I). _Type II: When aesthetic cases are sensitive to tooth-contact forces because a major resto- ration is being fabricated on the load-bearing areasoftheanteriororposteriorteeth(aswhen utilising inlays, onlays, overlays, crowns and bridges, veneers, dentures, or performing a re- restoration of frequently fractured restora- tions), force-finishing procedures should pre- cede aesthetic case finishing. This will improve the long-term clinical success of the restora- tion and create effective functional health. Force finishing in type II cases requires the use ofdigitaltechnology(T-ScanIII)thatcanmeas- ure and display the underlying tooth-contact forces precisely and objectively. The type II MCCF finishing protocol is shown in Table II. _Type III: Complex aesthetic cases (full-mouth restoration, orthodontic treatment, implant restoration, cases with para-functional habits, restorations that alter the anterior guidance, cases with a known history of TMD symptoms) require significant tooth-contact force and Table II_Type II MiCD case-finishing protocol. cosmeticdentistry 3_2012 Clinical steps Finishing tools Guiding tools Step I: Force finishing Force-finishing kit _T-Scan III During centric closure movement: _Articulating paper 1. Bring all the teeth into occlusal contact by selective contouring. 2. Measure tooth-contact forces and timing sequences on the restorations. 3. Adjust early contacts to delay them from contact, which improves contact simultaneity. 4. Adjust high contact forces on the restoration. 5. Adjust tooth-contact forces on restoration selectively until force equality is established throughout. During excursive movements: 1. Check for prolonged frictional contacts on the restorations during right, left and protrusive movements. 2. Removeallprolongedfrictionalcontactsontherestorations. Step II: Aesthetic finishing Aesthetic-finishing kit _Dental loupe Aesthetic touch-up: _Digital images 1. Achieve natural surface details through texture, _Digital X-ray grooves, pits and other special surface effects. (to check restoration Polishing: marginal fit, finishing 1. Pre-polishing: Remove the remaining surface scratches and overhangs) after the aesthetic touch-up process. 2. Polishing: Establish a blemish-free and smooth surface with no visible scratches on the restoration. 3. Super polishing: Polish restoration to enamel-like lustre. Step III: Finishing evaluation _Dental loupe 1. Evaluate aesthetics, health (dental and gingival) _Digital images and comfort status. _T-Scan III 2. Confirm force-finishing end-results. 3. Document the final case-finishing results digitally. Table II