cosmetic dentistry - beauty & science

I 13 special topic _ minimally invasive cosmetic dentistry I cosmeticdentistry 3_2012 timing management. In these complex restora- tive cases, force finishing is performed before aesthetic finishing is accomplished in order to achieve enhanced occlusal function and ideal aesthetics, combined with teeth, muscle and joint harmony. The type III MCCF protocol is shown in Table III. All three types of force finishing should al- ways be in harmony with the aesthetic results. After force finishing, the micro-aesthetic ele- ments should be re-examined, and cases should be completed with the necessary aesthetic touch-ups, and super polishing of all restora- tions. It should be remembered that the force- finishingprocessshouldbefollowedbyaesthetic finishing to complete the case successfully. _Conclusion In the performance of cosmetic dentistry, the force components are frequently neglected or misunderstood. Therefore, the physical strength of the tooth-coloured restorative materials is still an important topic in cosmetic dentistry. The restorative materials chosen are often much stronger than the natural teeth because the clinician hopes the materials selected will over- come potential fracture of the restorations. However, it is necessary to understand that the highly concentrated occlusal force locations within the occlusal scheme may not always fracture the restorations, but will create other problems with the teeth, muscles and/or joints in some patients. Therefore, if the clinician over- comes fracture of the restorations through ma- terial choice, he or she may actually be ignoring the underling force factors.68 It is to be noted that whatever the theory or concept of occlusal scheme selected during the treatment procedure, the role of MCCF is paramount to achieving long-term optimum results in terms of health, function, aesthetics and high patient satisfaction with minimal biological cost._ Editorial notes: A complete list of references is available fromthepublisher. The author does not have any conflict of interest regard- ing the products mentioned in this article. This article originally appeared in the MiCD Clinical Journal, 2011 Dec-Mar;01(1):32-42. Reprinted with permission from Vedic Institute of smile Aesthetics(VISA) Table III_Type III MiCD case-finishing protocol. Dr Sushil Koirala is the Chairman of and chief instructor at theVedic Institute of SmileAesthetics.He maintains a successful private practice in Kathmandu,Nepal. He can be contacted at skoirala@vedicsmile.com. _about the author cosmeticdentistry 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. 3. Adjust early high-pressure points, one by one. 4. Equalise right and left arch-half force percentage. 5. Distribute nearly equal force percentage on each posterior tooth counterpart, one by one (i.e. left first molar region should nearly equal right first molar region force percentage). 6. Keep light tooth contacts (lower force percentage) in the anterior region. 7. Check the location of COF and bring it down the midline and to the centre of the distribution of all contacting teeth. 8. Achieve simultaneous contacts of all teeth during mandibular closure. 9. Adjust tooth-contact timing of implant restorations selectively to delay them from making initial occlusal contact until after the nearby (to the implants) natural teeth make moderate occlusal contact. During excursive movements: 1. Check for prolonged frictional contacts on the restorations during right, left and protrusive movements. 2. Remove all prolonged frictional contacts on the restorations so that the disclusion time is reduced. 3. Achieve canine-protected guidance whenever possible. Step II: Aesthetic finishing Aesthetic-finishing kit _Dental loupe Aesthetic touch-up: _Digital images 1. Achieve natural surface details through texture, grooves, _Digital X-ray 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. _JVA 3. Document the final case-finishing results digitally. _EMG Table III