hello I'm Dr Jenny bender and I'm an in-house clinician with glidewell this is Justine who
was my patient when she was a child many years later as a young adult we met again
as co-workers at glidewell Justine has always felt self-conscious of what she called her baby smile
she desired a more mature and confident smile together we decided to cosmetically enhance Her
Smile by addressing her underdeveloped appearance of her peglateral number 10. and roughness of the
incisal edges of her upper and lower interior teeth to create a symmetrical and beautiful
smile her upper and lower anterior teeth were treatment plan for Selective minor enameloplasty
of number six seven eight nine eleven and number 22-27 along with conservative cosmetic composite
Restorations of number 7 8 and 9. for teeth number seven eight and nine I first slightly roughened
up the enamel with diamond prep burrs using 37 phosphoric acid Edge I conditioned each tooth
for five to ten seconds and rinsed with lots of water thereafter to ensure Dentin is left moist
I like to apply gluma desensitizer to seal any potential opened dentinal tubules it also helps
disinfect and re-wet the tooth for the next step which is the adhesive agent by 3M Scotch Bond
Universal plus I scrubbed it in for 20 seconds and it air dried for five seconds prior to light cure
for 10 seconds I used omnicroma direct composite by tokiyama a resin based restorative material
that can aesthetically match the entire Vita shade with just one shade I finished and Polished with
fine Diamond Burrs and so Flex contouring and polishing discs I've been using the soflex system
since the 90s and I simply cannot practice Dentistry without them it's so easy to get
the line angles create symmetry natural shape and smooth quality back to the teeth soflex finishing
strips are gently used to remove any overhangs in the inner proximal area being careful not
to damage the gingival tissue or precious papilla if you aren't sure take a radiograph to make sure
one of the key qualities to an enduring restoration is to keep it smooth smooth the
smoother your restoration the longer it will last I continue to perform enamelplasty as the Cosmetic
composite Restorations start to take shape a perio probe or electronic digital caliper can
check the width measurements to ensure symmetry of number eight and nine a carbide egg-shaped
Burr is used to adjust the lingual aspects for ideal occlusion I recheck with floss again to
ensure Restorations do not have overhangs now that there's Symmetry and Harmony accomplished through
selective enamoplasty and bonded Restorations my attention goes to the peglateral number 10.
my initial approach to number 10 was to restore it with veneer but the large gingival embrasia
space between number nine and ten required me to place my margin more lingually to gain more
Aesthetics I decided to include the lingual and plan for a full coverage restoration to fix the
baby tooth appearance of number 10 I decided that obsidian all ceramic would be the most suitable
material to satisfy the patient's need for a full coverage crown with lifelike Aesthetics
using long tapered round-ended and football Diamond Burrs I prepare the tooth equidingively
with a 0.5 chamfer margin to provide enough material thickness and strength for soft
tissue control a two cord retraction technique is utilized prior to the digital final scan
using ultra dense Ultra Pack cord the first cord size 0 0 is for apical compression without
hemodent the second cord size one previously soaked with hemiden is for lateral deflection
after five minutes of compression the first cord is typically left in the sulcus and the
second cord is removed prior to scanning in this situation both cords were removed to get
more natural immersions profile during Crown design once the scan of the prep
opposing and biter completed I rechecked the prep and occlusal clearance by checking the
itero occlusal gram it's important to check your scan data acquisition before
the information is sent over to the glidewell i o and office fast design software and Design
Station artificial intelligence identifies the margin instantly as shown by the dotted Red Line
I checked it and marked my final margins making sure to view it from various different
perspectives I received a biotemps now Crown Proposal with just a few clicks and made Minor
Adjustments to dial in my contact parameters finally I use my FastMail i o in office Mill
to fabricate the bio temps now temporary crown chair side in just a few minutes
properly fitted bio temps now provisionals allow the soft tissue to heal to the shape
of the accurate margin after trying and occlusal bite check I cemented the temporary
with bifix temporary cement which is a dual curing composite based temporary cement from voco America
bifix temp offers High Aesthetics and simple application this picture
shows the conservative enameloplasty and bonding once the temporary has been seated
at the next visit Justine was happy with the appearance and fit I was happy to see that her
soft tissue had been groomed to close the black triangle between number nine and ten together we
determine the desired shade for her final crown we decided on shade A1 because it Blended well
with the surrounding teeth with the patient's approval we are ready to deliver the Cosmetic
Crown using a bonded adhesive cement protocol I cleaned the preparation with pumice preppies
slurry to remove any residual temporary cement then I treated the tooth with a 37 phosphoric
acid Edge for approximately 10 seconds followed by copious Water Rinse for 20 seconds and air dry
leaving the Dentin moist I avoid desiccating the tooth that might cause post-operative sensitivity
I desensitized with gluma to seal the dentinal tubules and to provide an antimicrobial effect
it also helped wet the tooth to prepare for the 3M Scotch Bond Universal adhesive agent which is
thinned out and light cured the inside of the crown was previously etched with hydrofluoric
acid by the laboratory to create micro mechanical retention chair side the inside of the crown is
treated with silane by monobon plus to act as a coupler for the crown to the cement I used nx3
Nexus third generation light cured resin cement to bond the crown onto the prepared tooth giving
me a flexible setting time to correctly position the restoration applying gentle pressure with a
bite stick helps keep the crown seated in the correct position during the curing process
tack cure mode is recommended for predictable curing and easier removal of excess cement
I gently removed excess cement with a clean micro brush and scaling instrument
make sure not to fully cure until the inner proximal areas are cleaned well
once satisfied make sure to light cure each surface for 10 seconds to complete the process
I always re-check occlusion afterwards for hyperocclusion after cementation
on a lower Arch I performed enameloplasty on teeth number 22 through 27 contouring the
teeth to a natural more even State obsidian glass ceramic Restorations can be retained
with conventional cements self-adhesive resin cements or adhesive resin cements
in this case I chose bonded cementation because it increases the crown strength also resin cement is
very color stable which makes it especially suitable in the aesthetic anterior Zone
the results show that the lab match the exact shade and shape that the patient had always wanted
since she was a child the ascetic appearance of the obsidian Crown exceeded her Expectations by
blending naturally with her surrounding dentition this case report demonstrates
how digital chairside workflow can simplify aesthetic cases the ability to scan a patient
design a crown and Mill a provisional chair side and easily deliver the restoration allowed me to
personalize the treatment plan with greater flexibility resulting in a beautiful result
I was so happy to reconnect with my former patient to deliver a brand new smile