Perfecting the Smile with Proper Planning
Amann Girrbach’s Ceramill line helps technicians plot out the best course of treatment
Making a patient smile can be very powerful. This case documents how proper planning can facilitate a long-lasting, esthetic restoration with minimal tooth preparation.
A 36-year-old female patient presented with severe tetracycline discoloration and a broad smile. After many years of feeling embarrassed by her dark smile, she opted to seek an esthetic treatment. Because of her broad smile and large wearing posterior restorations, the treatment plan included full contour posterior zirconia crowns and anterior IPS e.max® veneers (Ivoclar Vivadent, www.ivoclarvivadent.com). Overall, the patient was comfortable with the size and shape of her teeth, requiring just some minor adjustments for bilateral symmetry.
To begin, preoperative models were fabricated along with occlusal records. A duplicate model was also made to make the minor symmetry adjustments. The treatment plan included esthetic CAD/CAM provisionals to be placed the day of clinical preparation (Figure 1 and Figure 2).
After articulation, each arch was scanned using Amann Girrbach’s Ceramill Map400 fully-automatic scanner (www.AmannGirrbachAmerica.com). The Map400 offers technicians an advantage in that it allows the models to be mounted using a transfer kit rather than a bite registration to achieve the proper articulation. This is especially useful in large cases, but can also be advantageous in smaller situations. A bite registration may still be used with the scanner, but it is not necessary. The Ceramill Map400 also has a wide measuring field that helps minimize the number of scans and stitching required. This allows the technician to start the designing process immediately, without having to wait for multiple scans (Figure 3).
Once complete, the scans are used to design the virtual restorations using Amann Girrbach’s Ceramill CAD Mind software. Inputs from the analog articulator are placed into the Ceramill Artex® Virtual Articulator, and the veneers and bridges are easily created using the Ceramill tooth library. This saves a great deal of time in overall case completion. After the designs are created, the occlusion is automatically adjusted using the Artex Virtual Articulator (Figure 4 and Figure 5). Following design completion, an anterior provisional veneer bridge (including the connectors used for stabilizing the veneers during the provisional phase) and 2, 4-unit posterior bridge shells are made from PMMA material using the laboratory’s Ceramill Motion 2 mill (Figure 6 and Figure 7).
At this stage, the patient was able to see the restorations on the model prior to any preparation, making her feel more comfortable with the procedure and increasing her level of excitement for her new smile (Figure 8). Eight posterior crowns were prepared along with the limited prep veneers, which were specifically selected to maintain more of the patient’s tooth structure (Figure 9 through Figure 11).
The provisional bridges were fabricated from acrylic. Minor occlusal adjustments were made and the restorations were polished just before cementing them into place with temporary cement. The provisional veneers were also secured in place using temporary cement.
The patient was elated with her new smile, as were the clinical staff and laboratory technician. Both clinician and patient agreed that the patient would wear the provisionals for 3 weeks to see if she wanted to make any design changes prior to fabricating the final zirconia and e.max restorations.
The decision to undergo a full-arch reconstruction can be nerve-wracking for a patient, especially when the reconstruction is for purely esthetic reasons. In this instance, the Ceramill Map400 scanner and Ceramill Mind design software not only allowed the dental team to plan and execute an esthetic functional outcome with minimally prepped veneers, but also provided an intermediate solution that was particularly effective in helping the patient visualize the final results, achieving complete patient satisfaction. With the ability to produce restorations in a broad array of materials, including PMMA for the provisional, Ceramill Zolid translucent zirconia for the full contour bridges, and e.max for the veneers, the Ceramill Motion 2 mill also saved the laboratory technician both design and production time.
This case was a feel good case for the entire dental team. The patient was moved to tears by her new, albeit, temporary smile and left more excited than ever before to receive her final restorations.
Alexander Wunsche, CDT is the production manager at Zahntechnique Dental Laboratory, in Miami FL. Alexander specializes in complex implant cases and CAD/CAM technology. He works with Klaus Lampmann, CDT and owner of Zahntechnique.
For a video demo of the Artex Articulator, visit dentalaegis.com/go/idt403
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