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Dental Tribune Middle East & Africa Edition No. 3 2015

Dental Tribune Middle East & Africa Edition | May-June 2015 7mCME < Page 6 (Apple) or Microsoft PowerPoint is a very powerful communica- tion tool in obtaining treatment acceptance. Case presentation A 32-year-old female patient came to the dental office with her chief complaints being short teeth, an uncomfortable bite, too much gingiva showing when smiling, brown-coloured areas of her teeth and insufficient con- tact points. The patient was in good general health with a good periodontal status and probing depths of 2 to 3 mm. The aetiol- ogy of the excessive gingival dis- play was multifactorial, a com- bination of delayed eruption, altered passive eruption and hypermobility of the upper lip. From an evaluation of the teeth, both clinically and from the di- agnostic photographs, we made the findings given in Table 1 in order of importance (Figs. 13 & 14). We placed incisal edge posi- tion first in order of importance because, in the majority of cases, without proper placement what- ever follows could result in a tooth that tries to mimic nature but is not properly exposed in a full smile. Based on the data gathered, the treatment plan was then pre- sented to the patient in 3-D on models mounted in the articu- lator and in 2-D with a Keynote presentation, allowing her to understand the present situa- tion, treatment proposed and simulated final outcome. Following the treatment pro- posal and acceptance, the case was sent to the dental labora- tory, where the dental ceramist fabricated a wax-up and a stone model based on the clinician’s diagnostic findings (Figs. 15–17). A crown-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 mini- mum of 2 mm was maintained (Figs. 19–24). The mock-up should be placed before the surgical appointment for an initial evaluation and then ideally six to eight weeks post-crown lengthening. If done earlier, a very well-adapted in- direct acrylic prototype would be advised or the utmost care in adaptation of the bisacrylic resin (Figs. 25–27). For the ultimate control and when time management in a private office is not an issue, the osseous contouring is per- formed and the flap is closed, followed by guided gingivec- tomy 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 di- agnosis of the initial situation and underlying tooth structure, the new design proposal and the patient’s expectations play a very important role. The ma- terial 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 posterior zone (Figs. 30–33). As a rule of thumb, when a ma- terial like feldspathic porcelain is used, which filters the light through to the underlying struc- ture, a space of 0.2–0.3 mm is needed per shade change. The restorations were adhesive- ly cemented using a total-etch technique and initially tried in with a translucent try-in paste (CHOICE 2, BISCO, Inc.). The occlusion was checked af- ter cementation and a processed acrylic night guard was deliv- ered two weeks post-operatively. The final result is shown in Fig- ures 34, 36 & 37). Reference 1.RufenachtCR,PrinciplesofEs- thetic Integration:Quintessence Books, Carol Stream, IL, 2000. 2. Kois JC, Altering Gingival Lev- els: The Restoration Connection. Part 1: Biologic Variables J Es- thet Dent 6:3-9, 1994 3. Stephen J. Chu: Short Tooth Syndrome: Diagnosis, Etiology and Treatment management February 2004. VOL32. NO32. CDA. Journal Dr. Sebastian Ercus graduated from the dental faculty at Ovidius University in Constan, in Roma- nia. He subsequently obtained a Master of Science degree in Public Oral Health in 2005 from the same institution. HeisinprivatepracticeinBrussels. DentalSpecialtyCenter Av.FranklinRoosevelt82bte1 Ixelles/1050Brussells,Belgium smile@sebastianercus.com www.sebastianercus.com About the Author mCME SELF INSTRUCTION PROGRAM CAPPmea together with Dental Tribune provides the opportunity with its mCME- Self Instruction Program a quick and simple way to meet your continuing education needs. mCME offers you the flexibility to work at your own pace through the material from any location at any time. The content is international, drawn from the upper echelon of dental medicine, but also presents a regional outlook in terms of perspective and subject matter. Membership: Yearly membership subscription for mCME: 900 AED One Time article newspaper subscription: 250 AED per issue. After the payment, you will receive your membership number and Allowing you to start the program. Completion of mCME • mCME participants are required to read the continuing medical education (CME) articles published in each issue. • Each article offers 2 CME Credit and are followed by a quiz Questionnaire online, which is available on http://www. cappmea.com/mCME/questionnaires.html. • Each quiz has to be returned to events@cappmea.com or faxed to: +97143686883 in three months from the publication date. • A minimum passing score of 80% must be achieved in order to claim credit. • No more than two answered questions can be submitted at the same time • Validity of the article – 3 months • Validity of the subscription – 1 year • Collection of Credit hours: You will receive the summary report with Certificate, maximum one month after the expiry date of your membership. For single subscription certificates and summary reports will be sent one month after the publication of the article. The answers and critiques published herein have been checked carefully and represent authoritative opinions about the questions concerned. Articles are available on www.cappmea.com after the publication. For more information please contact events@cappmea.com or +971 4 3616174 FOR INTERACTION WITH THE AUTHORS FIND THE CONTACT DETAILS AT THE END OF EACH ARTICLE. Fig. 16. The new design proposal in wax. Figs. 19–24. Crown lengthening with osseous contouring. (Surgery performed by Dr Muriel Krischek, Belgium.) Figs. 25–27. The bis-acrylic prototype. Fig. 28. Controlled tooth reduction. Fig. 29. Tooth preparation. Fig. 30. Porcelain restorations on al- veolar models. Fig. 33. Situation before. Fig. 37. Final result. Table 1. Findings. Fig. 34. Situation after. (Ceramics per- formed by Edwing Chung, Canada.) Fig. 17. Very good communication with the dental laboratory. Fig. 31. The try-in paste and organ- iser. Fig. 35. Initial situation. Fig. 18. The crown-lengthening surgi- cal guide. Fig. 32. Cementation. Fig. 36. Situation five months post- op. Incisal edge position Missing Form Missing Value Missing Surface texture Missing Translucency Missing Chroma Missing Hue Present Gummy smile evaluation Missing Teeth ratios Missing Contact points Missing Occlusal interferences Present +97143616174

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