Achieving healthy and harmonious smile by following modern and predictable approach

Provisional restorations are one of the mandatory steps for an indirect restoration, especially in the anterior area. A correct multi-step protocol should start with planning of the treatment, and include a wax-up, and a mock-up.
Bis-acrylic resins are one of the easiest ways to fabricate a provisional restoration. Different advantages as easy handling, fast setting, repair, polishing and aesthetics turn this material one of the most popular for this purpose nowadays.

shy smile with upper lip hiding teeth style italiano styleitaliano

Fig.1
This patient came asking for an aesthetic improvement of her smile. Esthetic analysis showed that the incisal exposure should be increased.

intraoral view of short upper teeth style italiano styleitaliano

Fig.2
Initial occlusion of the patient showed that the teeth needed to be increased in length.

pre operative picture before esthetic veneer restoration style italiano styleitaliano

Fig.3
Initial situation (close-up view).

study cast in different views styleitaliano style italiano

Fig.4
Study cast before the wax-up.

waxed-up model for veneers style italiano styleitaliano

Fig.5
Wax up with the new design, in which teeth are elongated and shape improved.

resin, silicone index and wax-up style italiano styleitaliano

Fig.6
In order to quickly fabricate temporaries according to the esthetic project, a silicone key made from the waxed-up model.

resin injection in silicone index style italiano styleitaliano

Fig.7
DMG Luxatemp Star resin applied inside the silicone index. The mixing tip should be not removed from the silicone index until all the teeth are filled, in order to prevent internal voids. After placing the index in the mouth, we should wait for the gel phase before remove the excess material. Then keep the index in the mouth for two more minutes before removing it for polishing procedures.

resin mock-up style italiano styleitaliano

Fig.8
In order to meet the patient’s demand, the additive mockup was fabricated using a very bright bis-acryl resin (DMG Luxatemp Star Shade Bleach Light).

smile with mock-up style italiano styleitaliano

Fig.9
Smile situation with mock-up.

illustration of veneer preparation with and without mock-up style italiano styleitaliano

Fig.10
With the aim of minimizing enamel loss, preparation through the mock-up was chosen. In the picture you can see the difference in the amount of tooth reduction without (left) and with (right) a mock-up.

veneer preparations with retraction cord styleitaliano style italiano

Fig.11
After the thickness and the depth reduction, the dentist should focus on the preparation design and follow some basic rules:
– Respect buccal convexity
– Cervical margin located 0.5 supra gingival
– Proximal preparation margin at half the thickness of the contact area

final aspect of veneer preparation style italiano styleitaliano

Fig.12
Final preparation of the teeth (all reduction within the enamel).

putty and light impression materials style italiano styleitaliano

Fig.13
The impression was taken with a single step technique using DMG Honigum Pro Putty Soft and Light.

impression of veneer preparation style italiano styleitaliano

Fig.14
The light body material is very flowable and able to fill all the space created by the second retraction cord.

lithium disilicate veneers on model style italiano styleitaliano

Fig.15
Lithium disilicate (e-max) ceramic veneers were fabricated by the dental lab.

before and after veneers style italiano styleitaliano

Fig.16
Comparison between the initial and final smile (close-up view).

cemented lithium disilicate veneers style italiano styleitaliano

Fig.17
The final aspect of the restorations after one month from the cementation.

side view of lithium disilicate veneers style italiano styleitaliano

Fig.18
Final situation of the teeth with maximum integration between pink and white factors (side view).

smile of patient happy with veneers style italiano styleitaliano

Fig.19
The dentist and the patient were very happy with the final aspect.

before and after dental veneer makeover style italiano styleitaliano

Fig.20
Before & after.

Conclusions

Bis-acryl resin materials such as DMG Luxatemp Star, are an aesthetic, fast and easy solution to fabricate mockups and temporary restorations in the dental office.
As presented in this article the mock-up is the key element of every single esthetic treatment. The advantages are not only about the aesthetic project validation, but also about controlled preparation and function. In short, the mock-up is today to be considered crucial for three main reasons:
1- visualization of the final outcome (aesthetically and functionally)
2- guide for the buccal or occlusal reduction
3- fast and simple temporization

Bibliography

1. Mizrahi B. Porcelain Veneers: Techniques and precautions. Int Dent SA. 2007;9(6):6-16.
2. Gurel G. Predictable, precise, and repeatable tooth preparation for porcelain laminate veneers. PractProcedAesthet Dent. 2003; 15(1): 17-24
3. Magne P, Magne M. Use of ad- ditive wax-up and direct intraoral mock-up for enamel preservation with porcelain laminate veneers. Eur J Esthet Dent. 2008 ; 1(1): 10-19.
4. Magne P, Magne M. Use of ad- ditive wax-up and direct intraoral mock-up for enamel preservation with porcelain laminate veneers. Eur J Esthet Dent. 2008 ; 1(1): 10-19.

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