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ePaper created 2016-09-09, 12:12:48 | version 1.38.0
2_2016 22 sition for the definitive restorations, was made from a Siltec (Ivoclar Vivadent) impression of the 3-D White Wax-Up provided by the dental lab. Using a B1 shade of Structur 3 (VOCO America) temporary material, the Siltec mold was quick- ly filled and placed on the patient’s prepared dentition. Within minutes, the provisionals were fabricated and effortlessly trimmed with trim- ming burs and discs (Axis). Once the teeth were desensitised with Systemp desensitiser (Ivoclar Vivadent) and dried, the provisionals were tem- porarily 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 evaluation of aes- thetics, phonetics, and bite. Already he exhibited excitement and confidence with his provisional restorations, commenting that all his coworkers noticed he looked younger and happier. Most importantly, the patient said he no longer expe- rienced discomfort in his TMJ and that his bite never felt better. Since no adjustment or modi- fication of the temporary was needed, the den- tal lab was instructed to replicate the 3-D White Wax-Up when fabricating the definitive restora- tions. _Laboratory considerations The 3-D White Wax-Ups, colour photographs, impressions and bite relations were forwarded to the dental lab (Arrowhead Dental Lab). A scan of the 3-D White Wax-Ups was used to select an appropriate arch form, tooth size and occlusion from the library of teeth available in the 3Shape software (Figs. 6 & 7). Using 3Shape Commu- nicate, images of the proposed reconstruction were forwarded to my office by email. Any mi- nor adjustments in tooth shape and contour were communicated with the technical advisor to achieve the most ideal aesthetics. Once ap- proved 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 placement of the definitive res- torations. Once appropriately 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 Ze- nostar (Ivoclar Vivadent) crown restorations were tried in to verify marginal fit, contour and accu- racy. The patient was handed a mirror to examine the appearance of these restorations. Once satis- fied, he approved them for final cementation. As the restorations were removed from the patient’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 hydrox- ide which is for extraoral use only. Once shak- en, the material was applied to the restorations and then thoroughly rinsed, enhancing the bond strength between the indirect restoration and adhesive cement. The preparations were washed and dried; a single component, light cured ad- hesive, Adhese Universal (Ivoclar Vivadent), was applied to the teeth using the VivaPen (Ivoclar Vivadent) dispenser. In this particular case, Ad- hese Universal (Ivoclar Vivadent) was used with Fig. 6_3Shape Virtual Design biting. Fig. 7_3Shape Virtual Design open. Fig. 8_Zenostar monolithic restorations on model. Fig. 6 Fig. 7 Fig. 8 case report _ digital planning