Dental Tribune Middle East & Africa Edition

Backtotheclinicwithtry-in The patient had a clinical try-in of the final restoration; notes and desires of the dentist and the patient were taken into consideration. Disharmony was noted in the smile line (misalignment with the eye line) (Fig 8, fig 9, fig 10), an important issue that would have been missed if a clinical try- in was not done. And this is where tak- ing pictures of the patient’s lips and face plays a crucial role in the technician work quality, so he would be able to make the appropriate adjustments while observing these photos. Thirdbake; Fixing the smile line was the main adjust- ment needed, so I added incisal edge, creat- ed the Halo effect (which is caused, in natu- ral teeth, due to light refraction at the inci- sal edge), and is usually duplicated by us- ing certain material (IE powder from IPS Ceram Impulse). Posteriors crowns were built up using the layering technique with IPS Emax Ceram Dentin, Impulse and Incisal. (Fig 11) SurfaceTextureandglaze: Ovoid tooth usually is more convex than any other tooth shape, has a rounded out- er shape, and curvilinear transition angles with a few lobes. This is why a very nar- row and shallow vertical depressions were created on the labial surface of the centrals and laterals giving the interiors their soft esthetic composition. (Fig 12, fig 13) Closingthegingivalembrasures: As you noticed from the preop- erative situation, the unhealthy loss of the grayish interden- tal papillae is a consequence of wrong countering in the direct composite, where contact areas were elongated toward the tis- sue, what made the gingival em- brasures too close, impinging on the tissue and creating un- healthy periodontal condition. Therefore the tissue receded; and now for the papilla to grow back, the distance between the contact points and the tips of the papilla must be less than 5 mm, which was the main focus of the contouring on a non sep- arated stone model where pa- pillae are still represented there and work can be done relative- ly (fig 14). Cementation andfollowup: Upper anterior restorations and premolars were finally cement- The reflecting materials have to be ade- quately reflective without being opaque. The light-absorbing materials should not be applied excessively to produce grey and glassy looking results. We don’t want to fabricate teeth that look great on the model but appear gray and glassy in the mouth. Foundationbake. 1st. Shading the cervical third and bring it closer to A1 by using Shades from IPS Emax Ceram. 2nd. Since my goal is to create teeth that demonstrate the entire spectrum of ef- fects shown by natural dental enamel, I used Impulse material on the incisal third to achieve this spectrum. (Fig 5) 3rd. Sprinkling transpa neutral powder on the whole surface, to cover the parts that are not yet covered by powder materials, lowers the value of the V1 frame, and match it accurately to A1 value wise. Secondbake; I used shaded Cervical Transparent pow- der on the cervical third in the second bake. This material demonstrates slightly higher fluorescence than the convenient transpar- ent material, and gives us a smooth tran- sition to the pink gingiva. (Fig 6 , Fig 7 ) show clearly the internal effects on the up- per crowns and lower veneers after cemen- tation, the actual look in the mouth and the way they treat light. Dr Sami Bissasu Damascus, Syria samimbg@hotmail.com CDT Aiham Farah Damascus, Syria aihamfarah@gmail.com Contact Information Fig 14: Final work on a non-segmented stone model showing the interdental papillae closure. Fig 15: Final intraoral results and the accurate shade matching of the upper crowns and lower veneers. Fig 14: Fig 15: ed with variolink-N (Base and catalyst), lower anterior veneers with variolink- N (only Base), and posterior crowns with Vivaglass (glass ionomer) cement. ( fig 15 ) During the follow up appointment, a final check up and modifications were made to eliminate all occasional interferences. Conclusion: Being able to Choose the same ingot for fabricating every single restoration in this case (whether they were full crowns OR veneers) was a big advantage, it serves in achieving the accurate matching and har- mony among all the restorations in the fol- lowing dimensions (Value, Hue, Chroma, translucency, depth...) as long as the thick- nesses were close. Fig 8,9: The disharmony of the smile line noticed in the try-in photos. Fig10: After fixing the smile line, the natural harmony with the lips. Fig 11: The layered posterior crowns after glaze Fig 12,13: Shallow vertical texture on the labial incisal third. Fig 8 Fig 11 Fig 12 Fig 13 Fig 9 Fig 10 AL Shaqaek Bldg. Next to New Expo Center Sharjah to Dubai road Sharjah U.A.E Tel: 009716-5775177 Fax: 009716-5775277 P.O.BOX: 61800.shj E-mail: HighTDL@hotmail.com CONTACT US 9dENtal lab trIbuNEDental tribune Middle East & Africa Edition | November 2012