hello and welcome to chair sideline I'm your host Megan strong thanks for stopping by in
today's episode dr. ana-maria Mershon is entering this thetic zone she's replacing
some failing P FM's and restoring her patient's smile with Brooks her anterior she's also going
to demonstrate how she uses a bone sounding gauge instrument for aesthetic analysis and
a soft tissue laser to aid in creating a beautiful new smile dr. Marashi on
in today's clinical presentation you will see a beautiful treatment outcome utilizing
a material that is beginning to show an increase in popularity in the aesthetic zone for this case
I took advantage of the appealing look of Brock's er material for the interior restorations on seven
through ten and my Picasso diode laser to aid in healing of the tissue when these patients
first walked into my office she expressed her concern about her unattractive gingival color
and the darker tooth that stood out against the much brighter pfm crowns on eight and
nine patient was unaware of the long-standing periapical infection depicted here on the x-ray
of number seven upon clinical examination patient had no symptoms and to treat the
chronic apical periodontitis endodontic treatment was planned for the right-lateral the aesthetic
evaluation shows severely inflamed gingival tissue around these faulty P FM's with margins that are
probably invading the biological width there is an obvious asymmetry in the incisal edges
position among the centrioles and the laterals creating an unbalanced smile additionally the
shade of these crowns is not a simply lighter than her natural dentition you can see me here
using a bone sounding gauge for verification of the bony crests location the first band
indicates the average soccers of one millimeter depth the second line indicates the average
osseous crest location about three millimeter we were borderline here at about 2.5 millimeter
facially after discussing with the patient her aesthetic concerns and communicating the changes
in her new smile using the acrylic mock-up and the diagnostic wax up patient understood that
first the infection and the cause of the diseased tissue has to be eliminated followed by a healing
period before achieving her aesthetic goals after the endodontic treatment on numbers was completed
the truth was prepared and temporized and the patient was asked to return for the removal
of a defective crowns for the removal of the diseased circular epithelium around 8 & 9 for
which I'll use a soft tissue laser and for carry elimination followed by build-up and preparation
number 10 was included in the treatment plan to receive a browser interior veneer to aid in the
predictability of the enamel reduction I used the acrylic mock-up and a three-banded calibrated burr
from Rustler USA sinking this bird through the acrylic into the tooth helped me create precise
cuts to ensure preservation of enamel which is critical in achieving a successful bonding upon
removal of the pfm crowns we can observe that a significant amount of leakage took place under
dis margins while re prepping 8 & 9 I was very careful to stay equal gingival II and not to
further drop the margin epicly we can note that the biggest challenge for the technician here will
be matching the shade between the restorations that will be placed on the non-vital dark stumps
of 7 & 8 with the restoration placed on the vital teeth 9 & 10 to avoid the shade discrepancy and to
help the technician achieve patient's desire shade there are a few technique that I use to cover a
dark area of the prep such as the application of an opaque composite or internal bleaching
for non-vital teeth or as in this case you will see me use boost whitening gel for the external
whitening of 7 & 8 and a more opaque cement for the final delivery at the final delivery
appointment you will see how boost whitening gel in conjunction with a more opaque cement that will
mask the persisting dark stump will result in a successful shape match after the facial and
incisal enamel reduction for the veneer on number 10 was achieved Cary's were removed and cavities
were prepared to be filled to ensure that no calculus and no granulation tissue was still
present around 8 & 9 the instrument was used to mechanically remove the calculus and a soft tissue
laser was used to remove the diseased epithelium for the laser curettage the Picasso light soft
tissue diode laser was set at 1.5 watts with continuous wave and initiated fiber with light
paint like brushstrokes moving and keeping the fiber tip in contact with the epithelium not to
the tooth I obtained a soft tissue ablation that will help reduce the inflammation and will support
healing the tissue tags can be removed with 3% hydrogen peroxide highly infected and inflamed
areas will bleed but the Haifa tonic energy will produce coagulation and control the hemorrhage
the patient was placed in temporaries and then asked to return for the final impression after a
waiting period of six weeks to allow enough time for the tissue to heal at the final impression
appointment the temporaries are removed and the gingival tissue is evaluated it looks nice
and healthy and significantly improved from the first day patient came in so we are now
ready to proceed knowing that there will be less chance of bleeding and less risk of obtaining an
inaccurate impression here the preparations are being promised and the stamp shades are going
to be selected I'll use double core technique to vertically and horizontally displace the tissue
along with the compr caps to ensure capturing a clear margin capture medium body was used around
the tea and heavy body was used to load the full arch custom tray as we see in this picture due to
the very dark stamp reps sterno bleaching is performed and boost whitening gel is applied
on the non-vital teeth seven and eight for the delivery appointment I asked the lab to provide
me with two different sets of restorations one set resembled the diagnostic wax up that the patient
initially liked the second set had a more feminine look staring away from the square contour of her
old P FM's patient opted for the second set of brock's or interior giving her a more feminine
smile the case was seated with multi-link Atomics following the manufacturer's instructions note
that the multi-link translucent cement was used under the restorations on seven nine and ten and
due to a more persistent darker shade after the bleaching multi-link opaque cement was used to
mask number eight to avoid micro gap formation i don't wipe off the cement attack her for two
seconds then remove the excess while the cement is still in the gel state after all the excess
is removed to further prevent micro leakage I use liquid strip gel around the margin and cure
for twenty seconds with this aesthetic drug her material I achieved every goal that the patient
and I had for the outcome of this treatment these new restorations have a nice of eight
shape with Central's slightly longer than laterals giving the smile depth and beauty and a feminine
appearance the patient feels comfortable to smile and interact in conversation without the anxiety
of the previous restorative treatment flaws thank you for joining me today stay tuned for my next
case which will feature the highly aesthetic next generation of Bruckner material thank you
for that dr. Mershon well that about wraps it up for this episode of chairside live so on behalf
of everyone here at Glidewell dental thank you for watching it'll meet you right back here next time