cosmetic dentistry - beauty & science

I 23 patient communication _ diagnostic mock-up I cosmeticdentistry 3_2012 overall shape of the teeth in relation to the pa- tient’s face. It can easily be modified chairside as required. Moreover, the patient can see the expected result immediately and in some cases can leave the dental office with the diagnostic mock-up to show to family and friends. The diagnostic mock- up is also an invaluable tool to confirm that the dentist understands what the patient is seeking in terms of the aesthetic result, and to point out and discuss the limitations before any treatment is done, thus preventing post-treatment frus- trations for both the patient and the dentist. It is therefore very helpful in cases in which a com- promised outcome is expected. The diagnostic mock-up is an integral part of diagnosis and treatment planning. It can easily be done at the appointment dedicated to discussing the treatment plan with the patient, immediately before the procedure or during bleaching ap- pointments if the patient wishes to bleach his or herteethpriortotreatment.Mostpatientsappre- ciate this option, which may enhance their moti- vationandcooperation,especiallyiftheproposed treatment requires long or multiple appoint- ments. It also can increase their confidence in the practitioner. The diagnostic mock-up as a chair- side diagnostic approach enables the patient to better understand and participate in the treat- ment planning process and express his or her thoughts regarding the dentist’s proposed out- come. _Case reports Case I A 19-year-old female patient was concerned abouthermidlinediastemaandthemisalignment of her maxillary incisors (Figs. 1 & 2). The patient hadcompletedorthodontictreatmentafewyears before but the realignment relapsed. The patient refused any orthodontic treatment and was con- sidering diastema closure and veneers. Her max- illary teeth exhibited short clinical crowns caused by altered passive eruption. Radiographs showed that the bone level was at the cemento-enamel junction. No other relevant findings or pathology was noted. It was explained to the patient that crown lengthening was needed in order to retain the normal proportion of her maxillary incisors fol- lowingdiastemaclosure.Thepatientonlywanted an improvement in the teeth shape and align- ment and declined the periodontal surgery. It was explained that her central incisors would have a squared shape and would appear shorter and wider. In her case, a diagnostic mock-up was made in order to help her visualise the result and the limitations. Using the diagnostic wax-up (Fig. 3), a silicone putty matrix was confectioned (Fig. 4). The matrix was filled with Protemp Plus ma- terial (3M ESPE; Fig. 5) and placed on lubricated teeth. After setting of the material and removal Fig. 16_Pre-op photograph of patient’s smile (Case III). Fig. 17_Pre-op intra-oral view (Case III). Fig. 18_Diagnostic mock-up (Case III). Fig. 19_Intra-oral view of diagnostic mock-up (Case III). Fig. 18 Fig. 19 Fig. 16 Fig. 17