Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-11-19, 11:37:23 | version 1.38.0
05Dental Tribune Nordic Edition | 4/2015 TRENDS&APPLICATIONS In this article, I present a case that demonstratesthatusingmoderntem- porary crown and bridge materials fa- cilitates the fabrication of temporary restorations that achieve natural aes- theticsandmeetthehigheststandards ofreliability. Patients have high expectations, particularlywhenitcomestotheaes- thetic results of dental restorations. Thisisbecause,ontheonehand,sub- optimal results are mostly visible straight away and, on the other hand, “beautiful teeth”are all-important to achievethatradiantsmile. Modern methods assist dentists in manyways,allowingthemtoachieve predictable results, especially in termsofaesthetics.Inadditiontothe useofradiographs,photographyand specialsoftwarethatcansimulatevar- ious results on screen, the diagnostic mock-up is important, as is consulta- tionwiththepatient,whichalsodeals withthelimitsofdentalrestorations. Themock-upenablestheresultofthe planned treatment to be assessed in advance and requires comparatively little time and effort. Moreover, the result can be realised on a temporary basis using the relevant materials without having to perform irrever- sibleinvasivemeasuresstraightaway. The temporary materials used in this process are of particular impor- tance. They must be available in the respectivetoothshadesandbeableto withstand the high loads in the oral cavity for the time required by the patient to accept or, as the case may be, reject the changes effected with thetemporaryrestoration. This clinical case is an impressive example of the possibilities that the combination of a wax-up and mock- up offer. A 27-year-old female patient presented to the practice wishing to improve the situation in her maxil- laryanteriorregion,whichshefeltwas unsatisfactory (Figs. 1 & 2). The date forherweddinghadalreadybeenset. The findings showed agenesis of tooth#22,markedpalataldislocation of tooth #12, the inhomogeneous courseofthemaxillaryanteriorarch, clearly separated central incisors, as well as further malpositions in the maxillary anterior region (Figs. 3–8). The analysis of the posterior region showedaclearClassIImalocclusion. To begin with, impressions of both jaws were taken and models were produced. After careful analysis of the models, a diagnostic wax-up was prepared of the maxillary anterior region with the aim of correcting the malpositioned teeth, replacing the missing tooth and visually shaping thedentalarch(Figs.9–12).Inthenext step, a silicone impression was taken over the wax-up on the model and the resulting impression was then trimmed carefully. The course of the vestibulargingivacanonlybechecked when the impression is in place; in- cised markings enable precise intra- oral positioning of the impression. This was followed by the careful se- lectionofshadesforthepatient. The method presented describes the fabrication of a restoration and simultaneous adhesion to the condi- tionedteethinonestep.Alternatively, the temporary restoration can be produced and finished in the con- ventional manner, that is without simultaneous adhesion. Temporary adhesion is then carried out in a separatestep. Next, teeth #13–23 were selectively conditioned for 5–10 seconds using phosphoric acid, the acid was rinsed off and an adhesive compatible with self-curing composites was applied to the etched areas. After light poly- merisation of the adhesive, the sili- cone impression was filled with Structur 2 SC (VOCO; Fig. 13) and re- inserted on the dental arch (Fig. 14). During the plastic phase, the excess material can simply be removed owingtopriorcarefuladaptationofthe impression, and the correct amount of time for which the impression must remain in the mouth can be re- liablydeterminedbasedonthedegree of polymerisation of the material in the mouth. Owing to the prior adhe- sive stage, the restoration remains in themouthduringthistime. After complete polymerisation, after four minutes, the temporary restoration can be carefully finished intra-orally. Suitable instruments for this are a sharp scalpel and different- sized carbide rotary instruments. Should minor corrections be neces- sary,thesearedoneusingthematerial itself or the light-curing (flow) com- posite.Thefinishedresultisachieved using appropriate silicone polishers forcompositematerials. Oralhygieneisofgreatimportance. Interdental brushes, dental floss and, as a further aid, a chlorhexidine-con- tainingoralrinsewereusedonaregu- larbasis.Asfarasthepatientwascon- cerned, the outcome was worth the substantial time and effort required. Whenherreluctantsmilepriortothe treatmentiscomparedwithhersmile afterfinishingthetemporarycrowns, thedifferenceisstriking(Figs.15–21). Dental experience, the targeted use of diagnostic measures, manual dexterity and the use of high-quality materialsledtotheimpressiveresult, which won over the patient even as a temporaryversion.Fromadentalper- spective, this first stage of treatment to visualise the end-result proved to beacompletesuccess.Thepatientand dentistwereabletotestthefinalresult without the need for any invasive measures.Inthiscase,thepatientwas Perfectprovisionalrestorations Figs.3 & 4: Close-ups of the clinical situation.—Fig.5: Lateral view from the right.—Fig.6: Lateral view from the left;tooth #22 is missing.—Fig.7: Inharmonious dental arches.—Fig.8: Dysgnathic tooth position.— Fig.9: Frontal view of wax-up.—Fig.10: Detailed view of wax-up.—Fig.11: Right side of wax-up.—Fig.12: Left side of wax-up.—Fig.13: Filling of the silicone impression.—Fig.14: Reinsertion of the filled impression. 7 8 9 10 3 4 1 2 5 6 11 12 13 14 15 16 Fig. 1: Full-face portrait of the patient.—Fig. 2: Inharmonious maxillary anterior region;tooth #22 is missing. Figs.15 & 16:Temporary restoration of the maxillary anterior region. A case report ByDrIrfêoSaraivadeCamargo, Brazil 78910 34 12 56 11121314 1516