Lab Tribune Middle East & Africa Edition

lab tribune Dental tribune Middle East & Africa Edition | January-February 2016 1C Fig. 1: Initial situation Fig. 2: Simulation of the desired result by means of a direct mock-up Figs 3a and b: Soft tissue management with the help of the provisional restora- tion after the irst connective tissue graft Figs 4a to c: The result after the irst soft tissue graft Fig. 5: Second connective tissue graft Fig. 7: Try-in of the zirconia bridge framework Figs 6a to d: After the surgical intervention, a metal-reinforced provisional was placed and the shape of the pontic area was progressively shaped from concave to convex during the following months. IPS e.max® PRESS MULTI THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT • Monolithic LS2 restorations showing a lifelike shade progression • Exceptional combination of strength, esthetics and efficiency • For crowns, veneers and hybrid abutment crowns • Coordinated with high-precision Programat press furnaces • Maximum cost effectiveness in the press technique all ceramic all you need www.ivoclarvivadent.com Ivoclar Vivadent AG Bendererstrasse 2 | 9494 Schaan | Liechtenstein Tel.: +423 235 35 35 | Fax: +423 235 33 60 LIFELIKE ESTHETICS – EFFICIENTLY PRESSED > Page 2C Together towards pink-white esthetics by Dr. Jorge andré Cardoso, Dt Oleg blashkiv, Dr. rui ne- grão and Dr . teresa taveira, Portugal I n prosthetic dentistry, ef- fective communication between the clinician and dental technician is of para- mount importance. This article presents a case which, among other things, involved soft-tis- sue remodelling in the anterior region. Consistent close coop- eration between the dentist and the dental technician and their concerted action provided the basis for a successful outcome. Case presentation A 32-year-old female patient presented to our practice with an unsightly, defective anterior bridge extending from tooth 12 to tooth 21. The bridge had been placed seven years ago. As she was unsatisied with her smile, the patient was looking for an esthetic, more natural-looking alternative. The veneer of the metal-ceramic bridge had a very opaque and yellowish ap- pearance. In tooth 21, the metal margin was exposed cervically due to gingival recession. Al- veolar ridge atrophy in the area of the missing right central in- cisor (pontic) had resulted in a considerable vertical reduc- tion. The shape and shade of the teeth needed improvement and harmony between white and pink tissues had to be re- stored (Fig. 1). treatment plan and mock- up Since smile improvements in- volve complex procedures, it is advisable to simulate the inal result by means of a direct com posite mock-up. This important step enhances the trust and conidence of the patient. A mock-up provides the patient with a clear idea of what the ef- fect of the planned restoration will be once it has been seated in the mouth. In our opinion, this step cannot be entirely replaced by digital design pre- views. The mock-up allows the lab technician to obtain a bet- ter understanding of the indi- vidual clinical situation. Later on, the mock-up can be used as a template in the fabrication of the lab wax-up and/or the pro- visional restoration. In the case at hand, the mock- up revealed that in order to achieve a more balanced ap- pearance, tooth 22 needed to be integrated into the restoration (Fig. 2). And even more impor- tantly: it showed that not only the correct position, shape and colour of the teeth were key fac- tors in achieving a harmonious smile in this case, but also the correct gingival architecture and emergence proiles. Con- sequently, the patient was in- formed that, in order to achieve a satisfactory result, the soft tis- sue volume had to be increased in the pontic area. The patient fully agreed to the treatment plan suggested. The treatment plan involved: 1. the removal of the existing restoration 2. the placement of a provi- sional bridge and soft tissue grafting in the pontic area (soft tissue management that would take several months) 3. the insertion of a new ceram- ic bridge and a laminate veneer on tooth 22 and, if needed, also on tooth 13 Connective tissue graft and immediate provisional bridge Very frequently, tooth extrac- tion can be established as the possible cause of alveolar ridge atrophy. In this particular case, there was a considerable lack of volume due to bone loss in the pontic area. To re-establish the soft-tissue architecture, two surgical interventions “Communication is the answer to complexity.” This article demonstrates, once again, the importance of good cooperation between the dentist and the dental technician. were planned. Immediately after having performed the irst connective tissue graft, a provisional, lab-fabricated bridge was placed. The bridge was constructed on the basis of the mock-up information. It was reinforced with metal wire. The soft tissue contour- ing phase that followed took several months. Initially, the provisional exhibited an inner concave surface to provide suf- icient space for the soft tissue. Some authors suggest that the provisional pontic should have the inal convex shape. How- ever, having a concave initial shape allows for progressive tissue modelling from the pala- tal to the buccal side, which is helpful especially when several grafts are needed (Figs. 3a to 6d). Communication of emergence proiles and shapes to the lab Once the desired soft tissue shape has been achieved, one of the great challenges is to transmit all the relevant infor- mation, especially the length of the inter-incisal papillae and the pontic shape, to the dental lab. This is important because when the impression is made, the pressure of the impression material may deform the soft tissue. In order to prevent any possible loss of information, the pontic area of the provisional restoration was illed with a silicone-based impression ma- terial and then placed over the prepared teeth on the model (Figs. 7 and 8). This would provide the technician with a good approximation of the inal shape of the pontic. In order to determine the cor- rect location of the contact Tel.: +4232353535 | Fax: +4232353360

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