Download All I Want For Christmas... Front Teeth

Restorative TC-christmas
6/19/08
11:26 AM
Page 34
restorative townie clinical
All I Want For Christmas...
Front Teeth
This may be Christmas in July as this case documents a challenging set of composite veneers. Log on to the message boards of
Dentaltown.com today to participate in this discussion and thousands more.
ka
Posted: 12/20/2007
Post: 1 of 29
Total Posts: 153
I have been seeing this patient for a few months and have been working him up
with a view towards a comprehensive restorative plan once his etiology and risk factors are controlled. Patient is a bruxer, has gastritis with reflux, smokes 30 cigarettes
per day, consumes one to two bottles of white wine per day and is dental phobic.
We are doing well thus far and a month ago, I took records to initiate treatment.
He wanted to have a semblance of a smile for Christmas. I initiated treatment to
establish the incisal edge position so he could have his wish and will follow this
with, cores, clinical crown lengthening and pending compliance and stability the
final restorative phase. All this with a conformative approach.
Pre-op
Pre-op
Direct composite resin Same
build-ups. Tetric Evo Ceram
A2 / Tetric colour White
Finish for now
Conclusion: Hope he sticks to the
game plan. ■
jasonsmithson
Posted: 12/20/2007
Post: 3 of 29
Total Posts: 1416
Nice resin... most likely nicest I have seen on the boards.
For me, I would have preferred to angle distal line angles of laterals more
mesially (i.e. to midline). This is a “personal taste” thing and in no way detracts
from the case.
I bet the directs got you “buy in.”
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July 2008 ■ dentaltown.com
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continued from page 34
Why are you going comformative? Is it so you
can stage without total commitment to FMR [fullmouth restoration]? ■ Jason
dboudro
Posted: 12/20/2007
Post: 4 of 29
Total Posts: 673
You did a very
nice job for this
patient, better than
I can do. I’m sure
he’ll have a much
better Christmas. I also like the way you are handling
the case, it shows compassion for the patient yet conservative until stability/compliance is at least demonstrated in the short term. ■
sea_bass
Posted: 12/20/2007
Post: 7 of 29
Total Posts: 465
What do you use to contour
and finish? Really well done. ■
Jason, I decided conformative approach as soft tissue profiles are reasonable, clinical
crown heights can be managed
with crown lengthening. FWS,
closest speaking space OK.
Julio, these anterior restorations form part of the
diagnostic process for his treatment, if he smashes
them or not, either way it will give me further information. His dentition as you can see has much tooth
surface loss and these anterior build ups aside from
locating the incisal edge position, restored light anterior lingual contact between the anterior mandibular
and maxillary teeth with some freedom. I have put
him into a splint as well. Don’t know how things will
pan out, will just have to wait and see.
Polished these with the HfO [Hafnium Dioxide]
protocol diamonds, rubbers, and pastes with goat’s
hairbrush and then felt wheels. ■
ka
Posted: 12/20/2007
Post: 8 of 29
Total Posts: 153
sea_bass
Posted: 12/20/2007
Post: 9 of 29
Total Posts: 465
How do you create the surface detail, lobes, etc? I either
get too flat or a gouged look
when I try to create lobes I can’t
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continued from page 36
get that subtle irregularity. All I want for Christmas is your anterior skills and Jason’s
posterior skills. I also wish like I could golf like Tiger.
Keep posting. ■
bugalga
Posted: 12/20/2007
Post: 10 of 29
Total Posts: 32
I was thinking the exact same thing. I’d like Jason’s posterior skills and your
anterior skills as well. You’re not located in the U.S. are you, ka? My guess is that
you’re actually Vanini or Dietschi using the pseudonym “ka.” Most guys who use
HfO are abroad in the U.K. or Europe. Those are some sweet directs. Did you use
a lingual shell or is that all freehand? How long did that take you, six hours? ■
ka
Posted: 12/20/2007
Post: 12 of 29
Total Posts: 153
Thanks for your comments. Mounted models and diagnostic wax-up and
worked of a lingual matrix. Freehanded the rest. I only used one shade, Tetric Evo
Ceram A2 and White Tetric Colour.
Used diamonds to develop some macroanatomy and then pumice impregnated
rubbers to blend and modify, fine diamond polishing pastes with goat’s hair brush
and selectively superfine paste with a felt wheel.
In the pre-op, the 23 has almost no residual structure. I placed one teardropshaped Whaledent pin distally on the 23.
Took a two and a half hour appointment to place and two days later one hour
to finalize. ■
bugalga
Posted: 12/20/2007 ■ Post: 14 of 29
Total Posts: 32
Did you use the infamous pull-thru technique to get the contacts? ■
ka
Posted: 12/21/2007 Post: 15 of 29
Total Posts: 153
Pull thru technique? Not sure of that one. Can you describe it for me? ■
■
bugalga
Posted: 12/21/2007
Post: 16 of 29
Total Posts: 32
It’s when you place composite against a mylar strip from the facial interproximally then pull the mylar strip through while torquing slightly to the lingual to
“hug the tooth.” This will pull the composite towards the lingual. Afterwards you
go back and brush the composite towards the contact area on the facial and make
any minor adaptations prior to curing. Newton Fahl came up with it and there is a
small video clip by Mike Melkers in one of his threads. I don’t remember which one
though but it was a step-by-step direct composite veneer on a peg lateral. It works
really well for tight contacts. ■
ka
I haven’t heard Newton lecturing. He was here in Australia recently but I was
busy with some studies. I just used the wax-up to make a lingual/incisal matrix
with a raised surface on the distal occlusal like a kind of bite block for the patient
to rest his mandibular teeth on. I cut up a thin toffelmeier band into about one
Posted: 12/21/2007
Post: 17 of 29
Total Posts: 153
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centimeter sections. After building the lingual surface to just short of the interproximal contact points,
I inserted the little strips through the contact area
and into the putty matrix which made the strip stable, followed with a custom wedge and then built
the interproximal areas and contacts. I developed all
in this way and then came back and finished all the
labial surfaces. ■
d_utas
Nice job ka! I use a similar
Posted: 12/29/2007
technique but with teflon
Post: 19 of 29
plumber’s tape to produce tight
Total Posts: 4
contacts between the anteriors.
After the first one is built-up the
tape is wrapped across the inter-prox surface. The
next tooth can be built-up against the tape without
the problem of bonding to the other composite. I
learned the technique from Dr. Bruce Kleeberger.
Cheers. ■
ka
It will be interesting to see
Posted: 1/4/2008
how this one plays out. I saw
Post: 25 & 26 of 29
him yesterday; restorations are
Total Posts: 153
still there, in one piece, took a
hard line regarding the etiology
and management.
[Posted: 2/18/2008]
Review today, See photo. Poor compliance, does
anyone have any ideas on how to proceed. There
is only so much advice one can give, I guess I will
have to wait until he values his teeth. Hope there’s
something left to
work with.
Three months
later... What now? ■
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