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ePaper created 2017-05-10, 16:12:25 | version 1.38.0
the desired smile, correction of the malocclusion was needed in addition to bite raising and various restor- ative treatments. In the first step, the patient received an occlusal splint for six months (raising the bite by 2 mm as a fixed splint, Fig. 2). In the second step, clear aligners were manufac- tured for the patient to correct the malocclusion in the upper jaw. This was necessary in order to optimise the anterior teeth axes for the prosthetic treatment. Due to the very short teeth, I was aware that there were only limited chances of success. I advised the patient of this and indicated that even small changes in the axis would improve the situation. Furthermore, I had already seen in other cases what changes are possible and have a good load-bearing capacity. The patient was 100% ready and persevered until this stage of treatment was completed, otherwise, we would probably have seen no progress. Five times the patient received three splints in dif- ferent thicknesses with which the teeth were moved gently and retained with the hard splint until the end. Every step was based on an altered situation that al- ways came closer to the objective. At CA Digital, a new impression of the situation was needed after three steps, which made it possible to better check the sit- uation and also to adjust the movement situation. After three months, we had achieved an unspectac- ular but very important result: the correct axis of the anterior teeth was almost achieved. We were able to “tip” the incisal edge labially, which was very impor- tant for the prosthetic treatment. It can barely be seen with the naked eye as we are dealing in the micrometre range, but this alteration was significant for bite raising in the extension of the axis, as it would make correc- tion possible. The result can be seen clearly in Figure 3 as the anterior teeth were moved in facial direction by around 0.4 mm—a small but decisive advance from the initial situation of the prosthetic construction. new smile with CEREC Ortho industry report | Fig. 3 Fig. 3: Final situation after five aligner steps. The final model was placed over the initial model to show this. Changes in position are made visible using the colour scale. I then produced the posterior tooth restorations that were required for the bite raising in just one ses- sion using hybrid ceramics. The advantage for pa- tients is that, due to the flexible structure thickness, the ceramics increase the level of comfort with the level of pressure expected. Furthermore, the restora- tion was not necessarily perceived as a change in comparison to the natural tooth after the splints for bite raising were worn. I treated the teeth that were free from defects without additional preparation, which requires a material with a high edge strength that can be prepared extremely thinly in order to allow a clean transition to the tooth. The defect at 26 was integrated into the restoration for the bite raising. Like all teeth of the upper jaw, 27 also received a table- top or fixed bite block (Fig. 4a). Five days later, the mock-up, which had already been produced in the session for the posterior tooth Fig. 4a Figs. 4a & b: Posterior tooth restoration for bite raising in the Fig. 4b model and in situ. CAD/CAM 2 2017 51