The practice of dentistry today is not just repairing cavities or replacing missing teeth with restorations – it became an active part of aesthetic comfort feeling as Mr Alexander Wünsche elaborates.
Combined with plastic surgery or other aesthetic treatments, aesthetic dentistry is one of the most impactful tools to help human beings in feeling beautiful and gaining confidence. When we are looking into aesthetics and wellbeing, we automatically associate emotions. So, it would be a more proper way to describe aesthetic dentistry as – emotional dentistry.
Why emotional dentistry?
Most treatments take several weeks to finish before the patient finally receives the outcome he or she was looking for. During this time, emotions are a crucial aspect during treatment. We need these emotions to help us to achieve the target outcome and success.
The worst nightmare is when patients freak out when the first temporary is placed.
So, we already have to pay attention, that the provisional restoration not only looks good, but that the placement procedure is also running smoothly and that we have all the necessary tools, guides and other aids to place a temporary in the correct place. This requires pre-treatment planning and planning of the final outcome from the first moment we plan the treatment.
In the following case examples, I would like to show how proper treatment planning helps to arrive at a successful final outcome, without stressing the patient’s emotions.
The presented case is a 24-year-old photo model who went to overseas to have his smile corrected. The treatment plan was to minimally prep 10 anterior teeth in the maxilla and veneer via the direct bonding technique with composite. As we can see, the standard at which this was done, would never satisfy a 24-year photo model whose livelihood is his smile.
After nine months, he presented himself to one of my clients with whom I do aesthetic rehabilitations and explained that he was not happy with his smile and is deeply frustrated and depressed, since he has to hide his smile ever since coming back.
The patient was invited to visit me in my laboratory to take initial photos in my photo studio, so that we could evaluate his current situation and start planning (Figs. 1-4).
As we can see, the proportions and positions are grossly misaligned, and the tooth shade is not what the patient wishes for.
Planning started with a smile design and evaluation of the dentition
Presenting the proposed outcome in a digital manner not only allows dentist and patients to get an idea of the final smile, but also gives us technicians a guide which we can use throughout the whole treatment.
After the digital smile design was approved by the patient, it was printed with a 3D model printer. We need three different models to move forward – the current situation, the digitally designed and proposed design and a model with both situations combined. The last model was crucial, as it supports the treating dentist in prepping the current teeth as a visual guide. I also prepared silicone matrices of the proposed digital design model. One I left untouched, the other I cut horizontally into two pieces. This helped to guide during prepping the teeth, so that the exact amount will be prepped.
In our case, the treatment team decided for 24 crowns. The reason for not being able to fabricate minimal invasive restorations, was the pre-treatment with non-guided preps for composite veneers.
After receiving the impressions, face bow and bite records in the laboratory, models with the Giroform System from Amann Girrbach were fabricated and articulated in the Artex CR articulator. That allowed me to imitate all the patient’s movements properly as they were in the patients’ mouth.
The next step was to scan all the records (Fig. 6) with the Ceramill Map 400 scanner and start on the design. Throughout the design process, the occlusion and function can be fully controlled with the virtual articulator in the Ceramill Mind design software (Fig. 7). For maximum aesthetics, we decided to fabricate fully layered restorations. But to guarantee stable and long-lasting crowns, the restoration was designed with a minimal cutback for micro layering. Therefore, the digital smile design was digitally overlaid on the actual restorative design, so that the crowns were literally a copy of the smile design and just minimally reduced (Fig. 8).
The case is nested in the Ceramill Match 2 software so it can be milled in Zolid HT+ in the Ceramill Motion 2 DNA. I decided in favour of Zolid HT+, because the patient’s stump shade was in the darker range and the targeted final tooth colour is OM1.
After milling, the restorations were sintered overnight, I usually utilise overnight sintering with an eight-hour programme, to avoid any chance of stress to the zirconia.
The next day, all copings were seated on the master casts and GC ZrFs porcelain was applied with my own micro layer technique. Before glazing, we went through a bisquebake try in, so occlusion, function and aesthetics can be evaluated and minor adjustments were completed before all crowns went through a stain and glaze process.
Finally, our patient got his well-deserved and wanted smile (Figs. 8-9).
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