cosmetic dentistry_ beauty & science International Edition

I CE article _ interdisciplinary approach Based on the data gathered, the treatment plan was then presented to the patient in 3-D on models mounted in the articulator and in 2-D with a Keynote presentation, allowing her to understand the present situation, treatment proposed and simulated final outcome. Following the treatment proposal and accept- ance, the case was sent to the dental laboratory, where the dental ceramist fabricated a wax-up and a stone model based on the clinician’s diag- nosticfindings(Figs.15–17).Acrown-lengthening surgical guide (a vacuum-formed Essix appliance) was manufactured on a duplicate model of the wax-up for ideal osseous contouring during the surgical procedure (Fig. 18). The gingivectomy was performed following exactly the gingival margin of the wax-up and then used for guiding the osseous contouring, through which a biologic width of a minimum of 2 mm was maintained (Figs. 19–24). The mock-up should be placed before the sur- gicalappointmentforaninitialevaluationandthen ideally six to eight weeks post-crown lengthening. If done earlier, a very well-adapted indirect acrylic prototype would be advised or the utmost care in adaptation of the bis-acrylic resin (Figs. 25–27). Fortheultimatecontrolandwhentimemanage- ment in a private office is not an issue, the osseous contouring is performed and the flap is closed, followed by guided gingivectomy and mock-up placement at the next appointment in two to three months’ time. With this approach, the risk of recession or invasion of biologic width is reduced to the minimum. Controlled tooth preparation was performed through the mock-up using 0.6 mm depth-gauge burs (Figs. 28 & 29). In designing restorations, the diagnosis of the initial situation and underlying tooth structure, the new design proposal and the patient’s expectations play a very important role. The material of choice in this case was feldspathic porcelain (VITA Zahnfabrik) on a refractory die in the anterior zone combined with pressed lithium disilicate (IPS e.max, Ivoclar Vivadent) in the pos- terior zone (Figs. 30–33). As a rule of thumb, when a material like feldspathic porcelain is used, which filtersthelightthroughtotheunderlyingstructure, a space of 0.2–0.3 mm is needed per shade change. The restorations were adhesively cemented using a total-etch technique and initially tried in with a translucent try-in paste (CHOICE 2, BISCO, Inc.). The occlusion was checked after cementation and a processed acrylic night guard was delivered two weeks post-operatively. The final result is shown in Figures 34, 36 & 37)._ Fig. 35_Initial situation. Fig. 36_Situation five months post-op. Fig. 37_Final result. 10 I cosmeticdentistry 1_2014 Dr Sebastian Ercus graduated from the dental faculty at Ovidius University in Constanţa in Romania. He subsequently obtained a Master of Science degree in Public Oral Health in 2005 from the same institution. Hecompletedoneyearofimplantdentistryproficiency training at Carol Davila University of Medicine and Pharmacy in Bucharest in Romania in 2006. He completed the one-year Master Clinician Program in Implant Dentistry at the Global Institute for Dental Education in LosAngeles in the US in 2008 and the two-year full-timeAdvanced Esthetic and Restorative DentistryAdvanced ClinicalTraining Program at the UCLA School of Dentistry in LosAngelesin2011.DrErcusisasustainingmember of theAmericanAcademy of Cosmetic Dentistry. He is in private practice in Brussels. Dental Specialty Center Av.Franklin Roosevelt 82 bte 1 Ixelles 1050 Brussells,Belgium smile@sebastianercus.com www.sebastianercus.com cosmeticdentistry _about the author Fig. 37Fig. 36Fig. 35 CDE0114_06-10_Ercus 11.06.14 14:02 Seite 5