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CAD/CAM - international magazine of digital dentistry, Italian Edition, No.2, 2016

21 2_2016 case report _ digital planning (Fig. 4). The vertical dimension was increased by 1.5 mm. Based on information gathered from the initial consult and digital images, it was de- termined that the maxillary centrals could be lengthened by 1.3 mm to improve the As a result of the information gathered from the diagnostic wax-up, it was determined that aesthetics and function could be enhanced by restoring the en- tire dentition. Since tooth #31 was already miss- ing and tooth #2 already had a root canal, core and crown restoration, it was decided to aes- thetics. The canines would also be lengthened to restore canine guidance in lateral excursions. In regards to his lower anterior teeth, the goal was to correct the length to width ratio and create a less worn appearance. not remove this resto- ration since it did not oppose a lower tooth and it was not visible when the patient smiled. The final treatment plan would consist of crown res- torations, 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 strength with the aesthetics of natural tooth shades. Zeno star is especially suitable for making monolithic res- torations but can also be used as anaesthetic framework material. _Preparation When informed consent was obtained from the patient, treatment was initiated. After anaes- thetic was administered, any existing crown res- torations were removed and the teeth cored with composite if any old amalgam cores were pres- ent or there was any indication of recurrent de- cay remaining in the tooth using a Midwest Mul- tiPrep Carbide Bur (DENTSPLY). Adhese Universal bonding agent (Ivoclar Vivadent) was applied following the manufacturer’s protocol and cured using the Demi Ultra (Kerr) curing light. Using Multicore Flow Light (Ivoclar Vivadent), build-ups were accomplished on any teeth requiring cores. A Clear Reduction Guide (Arrowhead Dental Lab) provided with the 3-D White Wax-Up was used to insure adequate reduction for the definitive restorations. In other words, the Clear Reduction Guide allows the dental provider the ability to work quickly and comfortably knowing exactly how much to prepare each tooth for the best result. Using a coarse grit chamfer diamond bur 856 (Axis), the entire dentition was prepared for Zenostar crowns starting from teeth #3–15 and then teeth #18–30. Once these teeth were pre- pared, a sequential 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 technician in creating natural looking restorations. Utilising Expasyl (Kerr) we not only controlled haemorrhaging, 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 ma- terial (PMMA — polymethyl methacrylate) that becomes adjustable when heated in boiling wa- ter, these trays provided a quick, efficient way of capturing a dimensionally accurate impression with uniform thickness of impression material. Once molded and customised to the patient’s maxilla and mandible, full arch impressions were taken using a heavy and light polyvinylsiloxane impression material (Take One Advance, Kerr). After the impressions were completed, a bite re- lations jig fabricated on the 3-D White Wax-Up models 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 relations jig until he reached the vertical stops and the material set. Instructions for the size, shape, and colour of the final resto- rations was forwarded to the dental laboratory (Arrowhead Dental Lab) as well as the 3-D White Wax-Up models. _Provisionalisation A provisional restoration, which would aid in determining the best size, shape, colour and po- Fig. 3_3-D White Wax-Up. Fig. 4_Preparation guides and temporary guides. Fig. 5_Bite jig relined capturing full arch bite. Fig. 3 Fig. 4 Fig. 5

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