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Dental Tribune Middle East & Africa Edition | 3/2016 24 restorative ◊Page22 Figure27:Intra-oralICPview Figure31:Anterior toothpreps Figure29:Lowerstudycast Figure33:Restorationson thesilverdiesmodel Figure28:Viewoflowerarch Figure32:Silverdiesmodel Figure 30: Mounted study casts at new in- creasedverticaldimension Figure34:FinalcompletedviewinICP Figure35:Finalcompletedviewoflowerarch Figure36:Finalsmile contours by the further addition or subtraction ofwax.Thefinalcontoursofthecentralincisors should be determined first, followed by the lat- eralincisorsandcanines,sincethesymmetryof these teeth is not as critical as the central inci- sors. Step9:Restoration The final restorations can be seen in Figures 23 and 24. The step-by-step procedures in the res- toration will be discussed during the next case study. Casestudy Mr O was referred to me from Birmingham for a full mouth reconstruction (Figures 25-26). On examination there was marked amounts of wear present and loss of vertical dimension (Figures27-28).Mountedstudycastsweretaken and the vertical dimension – to which the final restorations were to be fabricated – assessed as per the previous discussion (Figures 29-30). The diagnostics and treatment planning protocols discussed in this paper were used to establish the ideal aesthetic and functional end result so that the diagnostic waxing, prep guides and prototypeswereproduced. Reconstructionthenfollowedalongestablished guidelines of initially an occlusion splint to es- tablish the correct RAP prior to starting tooth preparation procedures. All teeth were initially prototyped starting with upper and lower an- teriors then one side followed by another side overaperiodofthreevisitsduringoneweek. Once the prototypes had been in place for a period of time to establish the correct occlu- sion, function and aesthetics and the patient was comfortable, sections of prototypes were removed, definitive preps, impressions, oc- clusalrecordsandfacebowweretakenandfinal restorations fabricated and fitted. Again, upper and lower anterior crowns were fabricated and fitted first to establish and copy (via a custom- made incisal guidance table) the established anterior guidance (Figures 31-33). This was fol- lowed by one side then another in the same way. The final result can be seen in Figures 34, 35 and 36. Finally, a post-restorative splint was madefornight-timeuse. Acknowledgements Theauthorwouldliketothankthefollowingfor theirhelp: - Dr Ibrahim Hussain, BDS, M.Med.Sci.Implan- tology–implantsurgeon - Dr Andrew Watson, BDS, MSc, specialist in en- dodontics - Mr Bradley Moore – dental technician, ADS Laboratory,Harrogate. ProfessorPaulTiptonBDS, MSc,DGDPRCS(UK) DENTALSURGEON VisitingProfessorofRestorative andCosmeticDentistry,Cityof LondonDentalSchool www.colds.co.uk SPECIALISTINPROSTHODONTICS www.drpaultipton.co.uk TClinic@Manchester,Lon- don | www.tclinic.co.uk TIPTONTRAININGLtd www.tiptontraining.co.uk | www.bard.uk.com President of theBritishAcademyof RestorativeDentistry(BARD)