Courtesy of Dental Lab Products:
How can a major improvement of the shade and shape of teeth be simply achieved?
For quite some time, we have been hearing about minimally invasive techniques for the esthetic rehabilitation of the oral cavity. Whether a patient wishes to have stains removed, teeth bleached or the tooth shape and general appearance improved, the range of treatment options is almost unlimited.
Procedures include tooth bleaching, enamel micro-abrasion, direct composite restorations and the whole spectrum of laminate veneer restorations, ranging from full veneers—involving more aggressive preparation and the different types of thin or micro-veneers—to non-prep veneers and edge-ups. In cases where a major improvement of the shade and shape is desirable, indirect veneers are clearly the clinician’s first choice.
Because of their superior esthetic and mechanical properties, indirect veneers are ideal when extensive esthetic adjustments are required. Before the material is chosen, the clinician needs to understand the two main challenges of esthetic oral rehabilitation: selecting the proper shade and opacity of the material and determining the amount of tooth structure that needs to be removed in order to achieve the desired result. For example, in cases where teeth are moderately to severely misaligned and orthodontic treatment is not possible, aggressive preparation will be needed. The same applies to teeth with heavy staining caused by fluorosis or tetracycline.
A diagnostic wax-up is of paramount importance in order to evaluate the feasibility of the treatment. Once the wax-up has been created, it needs to be transferred to the mouth to demonstrate the possible esthetic outcome to the patient. A mock-up based on an impression of the wax-up is normally the method of choice. If the traditional protocol is followed, the clinician will have the chance to make small adjustments to the mock-up and discuss them with the patient after the teeth have been prepared and the temporary restorations placed. These adjustments are then communicated to the dental technician before the final restoration is fabricated.
In the case of non-prep veneers, a direct mock-up can be challenging to fabricate and the final outcome difficult to visualize due to the minimal thickness of the final restorations and the differences between the resin (used for the mock-up) and the ceramic (used for the final veneers). Presentation and imaging programs (which are easily available and affordable for everyone) are a novel option for simulating the final outcome. They allow digital mock-ups to be created on the computer screen. This method is extremely easy, accurate and reliable while saving cost and time. While a classical mock-up requires a chair time of 15-20 minutes, the digital mock-up can be done in less than one minute by the dental assistant or the clinician, if appropriate clinical and technical pictures are available. By superimposing a picture of the wax-up onto the pre-operative picture, a digital image of the final result is obtained. The only requirement is to match dimensions, inclination and perspective.
Click link to read on:
Also check out video with images from this clinical case: