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ePaper created 2015-11-12, 17:51:56 | version 1.38.0
case report _ restorative dentistry I have the excessive length of her anterior teeth ameliorated to harmonise with the surrounding dentition and to have the severe palatal curvature mitigated. _Planning and temporisation TheinformationgainedfromtheDSDprocedure and the try-in of the mock-up formed the basis for the final treatment planning. The mock-up model conveyed a precise impression of the morphologi- cal changes to be applied to the teeth. At the try-in, the canines were found to be too long in relation to the new appearance of the central and lateral in- cisors (Fig. 2). To redress this situation, the patient was given the option to have her canines reduced by approx. 1 mm following the insertion of the temporary restoration. Furthermore, the patient was informed of the need for surgical intervention to adapt the course of her gum line. Treatments necessitating a reduction of healthy tooth struc- ture and/or a change of the gingival profile require the use of visualisation software, such as the Digital Smile Design programme, because such changes cannot be made visible with models or mock-ups. After the existing restorations were removed with a tungsten carbide bur (Fig. 3), the resulting abutments were in a suboptimal condition and tooth 22 was damaged by a carious lesion. It was therefore necessary to build up the abutments using composite material and an adhesive before the temporary polymethyl methacrylate (PMMA) restorations could be placed. The primary objective was to avoid a further reduction of tooth structure. Aftercompletionoftheconservativetreatment,the built-up teeth were again slightly reduced to create space in the interproximal area with the aim to encourage the papillae to grow into the inter- dental spaces between the temporary restorations (Fig. 4). _Surgical intervention Surgical crown lengthening was performed to attainaharmoniousgumline.Aftertheperiodontal surgical soft tissue procedure, the bucco-lingual bonewasreducedusingadiamond-coateddrilland hand chisel with the aim to expose 5 mm of tooth structure above the alveolar bone crest. After the surgical intervention, the exposed root surfaces weresmootheduptothebonecrestwiththehelpof curettes, followed by the preparation of the abut- mentteeth.Here,theaimwastomodifythenatural emergence profile of the teeth as they emerge from the alveolar ridge and, as a result, to limit the coro- nal growth of the soft tissue portions in the buccal and palatal areas. Finally, the soft tissue flaps were secured over the buccal and palatal sides of the al- Fig. 3_Suboptimal abutments after removal of the existing restorations. Fig. 4_Abutments after having been built up with composite. Situation at the end of the first temporisation step. Fig. 5_Second temporary stage after surgical crown lengthening. Fig. 6_Intraoral digital registration of the temporary restorations. I 27CAD/CAM 4_2015 Fig. 4 Fig. 6 Fig. 3 Fig. 5 CAD0415_26-29_Monaco 06.11.15 12:00 Seite 2 CAD0415_26-29_Monaco 06.11.1512:00 Seite 2