ortho - the international C.E. magazine of orthodontics

ortho1_201322 I I clinical_ esthetics At this point, everything that could possibly be done for the left central incisor was finished. How- ever, could the orthodontist help with the future restoration of the right central incisor? When tooth preparation is done for a future veneer, the prosthodontist will remove the enamel. Even though adhesion to dentin is good, adhesion toenamelisbetter.Whenprosthodontistsworkwith veneers,iftheycanbondtoenameltheywillimprove the result. Having this knowledge, the orthodontist can still create a more favorable situation for his or her col- leagues. In this situation, if the right central incisor was placed a little more lingualized, the amount of tooth structure that will need to be removed for the veneer preparation will be less. Would it be possible for the orthodontist to lin- gualize that tooth? How is the orthodontist going to control the amount of tooth displacement? In this case,acompositeveneerwasbuiltonthebuccalface oftherightcentralincisor(Fig.11).Thefutureveneer has a thickness of 0.5–0.8 mm. The same thickness wasbuiltforthecompositeveneer.Acaliperwasused to confirm the thickness before and after the com- posite veneer was placed. The orthodontist placed the bracket on top of the temporary veneer, and the tooth was palataly displaced 0.5–0.8 mm. This way, thetoothpreparationwillbelessaggressive,andthe final veneer will have better adhesion to the enamel than to the dentin. With the orthodontic treatment in this case, we achievedamorefavorablesituationwiththesofttis- sue around the tooth that was going to be extracted, and a more advantageous position for the other centralincisorviaalessaggressivetoothpreparation. After the orthodontic treatment, it was time for the rest of the specialties to take over the case. Model (Fig. 12) wax-ups for the temporaries (not only for the extracted tooth but also a wax-up of the veneer) (Fig. 13) enable us to achieve the best sym- metry after orthodontic treatment. Therelativelylongtemporariesphase(Figs.14a,b) helps encourage a successful result (Fig. 14c). After the patient and the prosthodontist are satisfied with theprovisionalresults,anotherspecialistplaysarole in the patient’s treatment. The lab technician needs as much information as we can offer to be able to achieve the proper color and shade. Color guidance (Fig. 15) photographs and models should all be pro- vided to the lab technician. Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14a Fig. 14b Fig. 14c