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ePaper created 2018-03-23, 09:55:06 | version 1.38.0
16 DIGITAL Dental Tribune Middle East & Africa Edition | 1/2018 A combined digital orthodontic and restorative approach Case Study: By Dr Andrew Culbard, UAE Traditionally cosmetic dentistry was a term associated with the place- ment of crowns and veneers in the aesthetic zone, with many dentists adopting an aggressive preparation approach in order to facilitate the placement. Advances in cosmetic orthodontics and digital dentistry, coupled with a change in mindset towards pri- oritising the preservation of tooth structure has lead to many patients presenting for a cosmetic solution for their smile to undergo a multi- disciplinary approach. sented for cosmetic improvement of her teeth. In her own words, she wanted a wider and brighter smile with bigger teeth. Clinically the following issues pre- sented: 1. Peg laterals and canines in the up- per arch, with a generally anaesthetic tooth morphology throughout 2. Spaced upper arch with a lack of symmetry and some minor rota- tions on the canines 3. Lower arch had mild crowding 4. Starting shade was A3 5. The gingival zeniths were uneven, with some recession and a lack of keratinized tissue. The Patient, a 21 year old female pre- A treatment plan was constructed based on a facially driven smile de- sign, with calibrated images meas- ured against the invisalign clincheck software. The benefi t to using a digi- tal system here was to allow for accu- rate positioning of the anterior teeth for minimal preparation and the ideal restorative outcome. (Figs. 1a-f) A 7 week invisalign programme al- lowed for enough movement in the upper arch, while resolving the mild crowing in the lower arch. The fi nal tooth position can be seen in fi gure 1f. retention Post-ortho provisional was implemented with removal es- six retainers which were used for home whitening of the upper and lower teeth. A fi nal shade of BL3 was achieved, after 10 days of rehydra- tion. In this time the lab created a di- agnostic wax up guided by the smile design. A putty matrix was used to transfer the wax up to a trial smile (Fig. 2). Once the trial smile was approved by both patient and dentist, the acrylic was used as a guide for crown length- ening on the UR2, and then as a prep- aration guide for the APT technique (Fig. 3a-d). The fi nal restoration from UR4- UL4 were created from pressed Emax and cemented using Variolink LC neu- tral. Finally, defi nitive essix retainers were constructed for retention. Andrew Culbard BDS MJDF RCS Eng General & Cosmetic Dentist He works at the Dr. Roze & Associates Denta Clinic Dr Andrew graduated from the University of Glasgow Dental School in Scotland. He further pursued post-graduate training in a number of other dental specialities to ensure a diverse and well-rounded com- pliment of skills and knowledge. After 2 years of graduating, Andrew was awarded membership to the Royal College of Sur- geons of England. His interest in cosmetic and aesthetic dentistry has been his pas- sion throughout his career. Fig. 1a Fig. 1b Fig. 1c Fig. 1d Fig. 1e Fig. 1f Fig. 2 Fig. 3a Fig. 3b Fig. 3c Fig. 3d Digital Orthodontics Symposium Dr. Francesco Garino, Italy Prof. Ross Hobson, UK