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14 Dental Tribune Nordic Edition | 4/2016 TRENDS & APPLICATIONS (within a sufficiently large range of A1 to A3.5, including the Shades B, C and Bleach Light). The mechanical resistance of the material makes it possible to simulate the occlu- sion of the mock-up in the mouth. Self-curing composites are similar to conventional light-curing com- posites. As a result, the composite can be adhered to the mock-up in order to compensate for defects or change the shape (tooth elonga- tion, curvature of vestibular tooth surface, incisal cut-back, etc.). The retention occurs mechanically, that is no cement is required. In contrast to a temporary crown, the mock-up is ultimately destroyed upon removal. Step by step The clinical case presented here to illustrate the workflow was a consultation for aesthetic reasons. The patient wanted to improve his smile considerably without resort- ing to invasive techniques (I restrict myself here to the implementation of a mock-up in the maxilla). The first step involves taking a number of photographs in order to analyse the initial clinical situation with the patient (Figs. 2–5).11 A plaster model serves as the basis for pro- duction of the wax-up (Fig. 6). An impression is taken of the wax-up (Figs. 7 & 8), which is used in the mouth as a guide for the imple- mentation of the mock-up. The guide is tried in the mouth and any necessary corrections made with a scalpel. The shade of the self-curing composite (in this case, Shade A1) is now selected in accordance with the patient’s ex- pectations and the tooth shade of the natural teeth. The impression is filled with the composite (Fig. 9) and inserted into the mouth (Fig. 10). The im- pression is removed, at the ear- liest, 1.5 minutes after mixing (Fig. 11). However, final processing can only be performed after 4 minutes. The shape is adjusted either by means of contouring in conjunction with water cooling, as in the case of conventional com- posites, or by filling defects with a flowable composite (Grandio Flow, VOCO; Figs. 12–14). Finally, the structure and dynamics of the occlusion are verified. Once all adaptations have been completed, the mock-up is presented to the patient for his or her aesthetic approval regarding shape, position and tooth shade. If necessary, further adaptations can be effected in the same way, that is via contouring or filling with composite. The data is sent to the laboratory as photographs (portrait, smile and intra-oral; Figs. 15 & 16), along with an impres- sion of the mock-up and the anal- ysis of the smile. The dental tech- nician in the laboratory then has the necessary and sufficient in- formation at his or her disposal to produce the actual prosthetic restoration in accordance with the patient’s and dentist’s wishes.12 At the end of the treatment session, the question remains as to what to do with the mock-up. The dentist has the choice of two possibilities. One option involves removing the mock-up and per- mitting the patient to leave the practice with the restored initial clinical situation. No invasive or irreversible interventions have been performed and the patient is happy to have tried out his or her future smile without having to sacrifice any tissue or be anaesthe- tised. The other option is to allow the patient to leave with the mock-up still inserted. This allows him or her to show off his or her new smile to his or her nearest and dearest and to verify its accept- ance in social situations. Further- more, this enables the patient to test the articulation and masti- catory loads in daily life. At this point, it must be reiterated that the material is suitable for situa- tions of this type, as it was devel- oped for the production of tempo- rary crowns.4 It is up to the dentist to decide how long the mock-up can remain in the patient’s mouth, and it goes without saying that special attention must be paid to exceptional oral hygiene. From the perspective of the psychological period for visual acclimatisation and functional aspects, one week appears to be a practical period.4, 5 Discussion The mock-up technique offers a whole range of advantages. The quick, cost-effective method al- lows the patient to assess the de- sired result in his or her mouth.13 Until now, patients went along with dentists’ decisions without being actively involved in the treatment plan, and this occa- sionally resulted in unexpected outcomes and possible conflicts. A waiting period with temporary restorations makes it possible to assess the required result, but is not indicated in clinical cases with conservative or non-invasive ap- proaches. In future, the patient will be able to try out his or her new smile in order to become used to it quickly and even go home wearing it to test it extensively from an aesthetic, functional and psychological perspective. Patient compliance increases, as he or she can follow the treatment plan more calmly and is better in- formed. In addition to improved pa- tient communication, communi- cation with the dental technician is facilitated. Owing to the im- pression and photographs of the mock-up in the mouth, the dental laboratory has at its disposal a wealth of invaluable information, which was not systemically pro- vided in the past.12 The dental technician is then able to test the wax-up not only from a func- tional perspective (structural and dynamic occlusion, position of the free margin for articulation, lip support, etc.), but also from an aesthetic perspective (tooth shade, shape and volume of the teeth, smile symmetry, smile alignment with regard to facial aesthetics, etc.). The user friend- liness of the material means this technique is suitable for use in routine clinical practice. For the dentist, this technique is just as easy to perform as the production of temporary crowns. There is no need for a rubber dam, Fig. 14: Surface of the mock-up at tooth #21 after filling of the defect.—Fig. 15: Post-op situation, portrait.—Fig. 16: Post-op situation, occlusion check. 16 15 14 9 8 7 12 11 10 Fig. 7: Silicone wax-up impression.—Fig. 8: Verification of the accuracy of the wax-up impression.—Fig. 9: Filling of the impression with self-curing composite (Structur 3).—Fig. 10: Insertion of the impression with self-curing composite.—Fig. 11: Occlusal view of the mock-up after removal of the impression and all excess material.—Fig. 12: Filling of a bubble in the mock-up with flowable composite (Grandio Flow).— Fig. 13: Curing of the flowable composite. 13