hello welcome to cheer side live I'm Megan strong and I'm will Schmitt registered dental assistant
here at Gladwell dental on today's episode dr. Murray Shawn's got a case for us for her
patient had some aging veneers I choose number nine had a crown that was showing some gray due
to previous root canal therapy and there was some chipping and just they weren't blending
well they were showing their age exactly and I had the opportunity to assist dr. Murray respond
with this case so I can tell you firsthand the most nerve-wracking thing to do in dentistry
is take off someone else's old units you just never know what you're gonna find there Neath
this is what exactly lots of chocolates so she temporize --is with biotin Provisionals
and then she restores with Brooks er aesthetic restorations right and the provisional stage
played a key role in this treatment and you're about to see why let's check it out in today's
clinical case I am presenting Broxson aesthetic solid zirconia material I used to restore teeth
for 2:13 using a combination of crowns and veneers at the end of this case you will see
how this material transformed a patient smile from chipped and dark to beautiful and bright
this patient expressed great dissatisfaction with the appearance of her smile especially
the existing crown on tooth number 9 which did not blend well with the surrounding restorations
the patient had P FM's on teeth 4 and 5 IPs Emax veneers on teeth 6 2 8 10 11 and IPS Emacs crown
on to number 9 the previous veneers especially number 8 were fractured and chipped considering
that these veneers were bonded to a normal because they were no prep it's likely that they failed due
to the weakness of the ceramic material and not due to the lack of enamel present Broxson
aesthetic restorations are an ideal solution for this case because they have an average fracture
of strength of 870 mega pass representing a substantial increase in durability over other
interior grade solutions these pre-existing veneers were all no prep veneers and had
lost their marginal integrity so I expected to have some exposed dentin in some areas after
removing the caries my preference when I have exposed dentin and more than 50% of anomalies
gone is to go to a material that has high flexural toughness such as Brock's or aesthetically veneer
which was an excellent option for this patient after removing the previous crowns on to number
nine and all remaining P FM's and veneers we can see significant marginal leakage and caries that
needed to be eliminated but I was happy to see that some of the underlining enamel was still
intact patience to number nine had been previously treated with a root canal therapy and featured a
dark discoloration dude number nine was cleaned and rebuilt up to proper form using a dual cure
reinforced core material before planning a case it is important for me that I understand the end
result desired by the patient in this case the patient wanted a very light shade this required
that I will take her from the existing 3m tree shade to a om1 bleaching shade on the vita tree
d master to ensure that the dark shade would not show through the restoration i use external
bleaching to eliminate the dark cervical on number nine and also to whiten her lower teeth I also use
pink opaque ur from Cosmo dent after completing the external bleaching the patient was provisional
eyes with bio temps temporary restorations biotin Provisionals our patient specific temporaries
their morphology more accurately matches that of the final restoration and is helping to shape
the gingiva so there will be no surprises at the patients final visit I can use these Provisionals
to train the gingiva after the gingiva to me i perform above 7 & 8 with the goal of matching
the gingival architecture of tooth number 9 and 10 this temporization period was also extended
to ensure that the tissue that under when the laser Jinja vechta me was allowed sufficient
time to heal it should be noted that external bleaching of a preparation has the potential
to interfere with the bonding protocol of the final ceramic restoration so it was important
to provisional eyes for an appropriate amount of time ultimately keeping the patient in a biotin
provisional provided a durable solution for approximately six weeks final impression was
taken we can see that some of the underlining animal was largely still intact I delivered the
final proxy aesthetic restorations using very linked aesthetic a total edge system I apply
phosphoric acid gel to the enamel and allowed to react for 15 to 30 seconds rinsed and dried
followed by the g5 desensitizer then i coated the entire bonding surface using a dis Universal
and like cured I sit at the unit's starting with more distal restorations the bicuspid moving on
to the centrioles then laterals and lastly to the cuspid after tacking cured the excess was easily
removed with an explorer like all other composite resin the relink aesthetic is subject to oxygen
inhibition to counteract this effect I cover all the margins using the syringe of like liquid
strip then light cure again and resolve Roxette aesthetic provided a straightforward solution due
to its precision feet lifelike translucency and long-term predictability the overall appearance
of the restorations met the patient's expectation taking her from an aesthetic dark shade to a very
bright bleached look the overall durability of this new zirconia will provide the patient with
a long lasting and beautiful restorations this patient was extremely pleased with the final
outcome her smile was transformed and looked natural and bright by utilizing a conservative
approach as well as a versatile material such as Brock's aesthetic I addressed the function
and cosmetic needs of this case a beautiful smile was achieved that is attractive to the patient and
clinician alike well thank you so much for that dr. Mears on your attention to detail is second
to none well that wraps it up for today's episode of chairside live so on behalf of everyone here
at rival dental thank you so much for watching and we'll meet you right back here next time
you