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CAD/CAM - international magazine of digital dentistry

digital planning case report | 27CAD/CAM 2 2016 not remove this restoration since it did not oppose alowertoothanditwasnotvisiblewhenthepatient smiled. The final treatment plan would consist of crown restorations, placing composite cores where needed from teeth #3–15 in the upper arch and teeth #18–30 in the lower arch. The material of choice for these crown restorations would be Zenostar (Wieland, Ivoclar Vivadent). According to the manufacturer, this translucent zirconia material combines excellent flexural strengthwiththeaestheticsofnaturaltoothshades. Zenostar is especially suitable for making mono- lithic restorations but can also be used as anaes- thetic framework material. Preparation When informed consent was obtained from the patient, treatment was initiated. After anaesthetic was administered, any existing crown restorations were removed and the teeth cored with composite if any old amalgam cores were present or there was any indication of recurrent decay remaining in the tooth using a Midwest MultiPrep Carbide Bur (DENTSPLY). Adhese Universal bonding agent (Ivoclar Vivadent) was applied following the man- ufacturer’s protocol and cured using the Demi Ultra(Kerr)curinglight.UsingMulticoreFlowLight (IvoclarVivadent),build-upswereaccomplishedon any teeth requiring cores. A Clear Reduction Guide (Arrowhead Dental Lab) provided with the 3-D WhiteWax-Upwasusedtoinsureadequatereduc- tion for the definitive restorations. In other words, the Clear Reduction Guide allows the dental pro- vider the ability to work quickly and comfortably knowing exactly how much to prepare each tooth for the best result. Usingacoarsegritchamferdiamondbur856(Axis), the entire dentition was prepared for Zenostar crowns starting from teeth #3–15 and then teeth #18–30.Oncetheseteethwereprepared,asequen- tial bite was obtained using Blu-Mousse VPS (Parkell) bite registration material. A stump shade (Ivoclar Vivadent) was selected for shade matching of the preparations to assist the laboratory techni- cian in creating natural looking restorations. Utilising Expasyl (Kerr) we not only controlled hae- morrhaging, but also achieved gingival retraction. After approximately two minutes in the sulcus, the Expasyl was rinsed off thoroughly with copious amounts of water. A full arch impression was taken using Instant Custom C&B Trays (Goodfit). Made of a proprietary material (PMMA—polymethyl methacrylate) that becomes adjustable when heated in boiling water, these trays provided a quick, efficient way of cap- turing a dimensionally accurate impression with uniform thickness of impression material. Once molded and customised to the patient’s ma- xillaandmandible,fullarchimpressionsweretaken using a heavy and light polyvinylsiloxane impres- sion material (Take One Advance, Kerr). After the impressions were completed, a bite rela- tionsjigfabricatedonthe3-DWhiteWax-Upmodels from Arrowhead Dental Lab was tried in the mouth. Light body impression material (Take One Advance, Kerr) was placed into the relations jig and seated into the patient’s mouth on to the prepared teeth (Fig. 5). The patient was asked to bite into the re- lations jig until he reached the vertical stops and thematerialset.Instructionsforthesize,shape,and colour of the final restorations was forwarded to the dental laboratory (Arrowhead Dental Lab) as well as the 3-D White Wax-Up models. Provisionalisation Aprovisionalrestoration,whichwouldaidindeter- mining the best size, shape, colour and position for the definitive restorations, was made from a Siltec (Ivoclar Vivadent) impression of the 3-D White Wax-Upprovidedbythedentallab.UsingaB1shade of Structur 3 (VOCO America) temporary material, the Siltec mold was quickly filled and placed on the patient’s prepared dentition. Within minutes, the provisionals were fabricated and effortlessly Fig. 5Fig. 3 Fig. 4 Fig. 3: 3-D White Wax-Up. Fig. 4: Preparation guides and temporary guides. Fig. 5: Bite jig relined capturing full arch bite. 22016

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