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ePaper created 2016-06-17, 10:57:49 | version 1.38.0
| case report digital planning 28 CAD/CAM 2 2016 trimmed with trimming burs and discs (Axis). Once the teeth were desensitised with Systemp desensi- tiser (Ivoclar Vivadent) and dried, the provisionals were temporarily cemented using Temp Bond Clear (Kerr). The patient was instructed about their care and use in eating, speaking and biting. A few weeks later, the patient returned for evalua- tion of aesthetics, phonetics, and bite. Already he exhibited excitement and confidence with his pro- visional restorations, commenting that all his co- workers noticed he looked younger and happier. Most importantly, the patient said he no longer ex- perienced discomfort in his TMJ and that his bite never felt better. Since no adjustment or modifica- tion of the temporary was needed, the dental lab was instructed to replicate the 3-D White Wax-Up when fabricating the definitive restorations. Laboratory considerations The 3-D White Wax-Ups, colour photographs, im- pressions and bite relations were forwarded to thedentallab(ArrowheadDentalLab).Ascanofthe 3-DWhiteWax-Upswasusedtoselectanappropri- ate arch form, tooth size and occlusion from the library of teeth available in the 3Shape software (Figs.6&7).Using3ShapeCommunicate,imagesof the proposed reconstruction were forwarded to my office by email. Any minor adjustments in tooth shape and contour were communicated with the technical advisor to achieve the most ideal aesthetics. Once approved the provider and the patient, the milling process was begun (Fig. 8). Cementation The patient returned three weeks after the postoperative appointment for removal of his provisionals and place- ment of the definitive restorations. Once appropri- ately anaesthetised, the provisional restorations were removed with the Pneumatic Crown Remover (DentCorp, NJ). Any remaining temporary cement was removed and the teeth further cleaned with chlorohexidine 2 % (Consepsis, Ultradent Products, Inc.). The Zenostar (Ivoclar Vivadent) crown resto- rations were tried in to verify marginal fit, contour and accuracy. The patient was handed a mirror to examinetheappearanceoftheserestorations.Once satisfied, he approved them for final cementation. Astherestorationswereremovedfromthepatient’s mouth, they were cleaned with Ivoclean (Ivoclar Vivadent), a universal cleaning paste indicated for cleaning of prosthetic restoration surfaces that have been contaminated during intraoral try-in. The active ingredient is sodium hydroxide which is for extraoral use only. Once shaken, the material was applied to the resto- rations and then thoroughly rinsed, enhancing the bondstrengthbetweentheindirectrestorationand adhesive cement. The preparations were washed and dried; a single component, light cured adhesive, Adhese Universal (IvoclarVivadent),wasappliedtotheteethusingthe VivaPen (Ivoclar Vivadent) dispenser. In this parti- cular case, Adhese Universal (Ivoclar Vivadent) was used with the self-etch technique although it can also be used with the selective-etch or etch-rinse techniques. Care was taken to insure there was no pooling of the adhesive before curing it for ten seconds with the curing light. The crown restorations were seated utilising a neu- tral shade of dual-curing adhesive resin cement, Variolink Esthetic DC (Ivoclar Vivadent), starting from the midline and working out distally to pre- vent any canting of the restorations. The resto- rations were secured until final polymerisation was achieved. According to the manufacturer, some of the advantages of this cement are excellent shade stability, lifelike fluorescence, easy clean up, and increased radiopacity.Fig. 8 Fig. 6: 3Shape Virtual Design biting. Fig. 7: 3Shape Virtual Design open. Fig. 8: Zenostar monolithic restorations on model. Fig. 6 Fig. 7 22016