Direct mock-up digital workflow for ceramic veneers
The need for a digital workflow has become quite trendy in the dental world to take records and spend time on an electronic device for treatment planning. It all seems so simple and we feel we are doing a job which is contemporary.
It is a known fact that bonding is best achieved when done to enamel, so the goal of indirect veneers should be additive as much as possible. This, as stated in previous articles, can be achieved by pre-prosthetic orthodontics, bleaching, preparation through a mock up and with the vertical preparation technique.
Time is also of the essence and it works in a clinician’s favour when the result of the treatment suggested and executed has the least promise gap.
Quite often there is a sense of “what if it will not look good in the mouth although it seems alright on the computer” and “Will it alter my speach?” or “Will I be able to bite normally?” are common concerns that affect the patient we receive in our daily practice.
Also, with the popularity of social media and with smart phones being used a common entity, easy and quick communication helps suggest treatment. Quick and effective communication also reduces steps and time for both the clinician and the client.
A very valuable tool in the initial consulting of the patient who wants to have indirect veneers as a treatment choice is a Direct Mock Up. A case is shown and dos & don’ts are explained for an effective direct mock up.
A very simple device used for MDP (Mobile Dental Photography) is also being used more and more and a case of quick communication is being shown with the device with a direct mock up.
The author would like to thanks DT, Lamberto Villani, Oral Design, Dubai for this valuable support in fabricating the veneers.
Do not etch the tooth tissue and, keeping this in mind, do not use a self-etching adhesive system for the mock-up.
Use a medium opacity shade of restorative resin as the very translucent ones give a greyish appearance which, sometimes, is not appealing to patients.
[This image is for illustrative purposes and is not of the case being presented]
1) Very quick transfer of images not needing attachment to change size, then attach to an email. On receiving the images the patient has to open an email and download them.
2) Due to built-in compression algorithms in the messaging applications images are relatively of small size there by enabling them to be shared with whoever the patient might want to include in the decision making process. This results in easier acceptance of treatment suggested.
Always mark the midline of the index. This enables quick orientation while seating it in the mouth and, hence, a more accurate mock-up at the preparation stage.
Take the stump shade before taking an impression as the materials cause dehydration of teeth and thereby a wrong shade might be chosen.
A Direct Mock up done in the initial phase of treatment is an invaluable tool for diagnosis, predicting the final outcome, patient and laboratory communication. It is an extremely effective tool in aiding treatment acceptance.
Smart phones and Smile Lite are revolutionizing the way we communicate with our patients making it effective and fast.
Magne P, Magne M. Use of additive waxup and direct intraoral mock-up for enamel preservation with porcelain laminate veneers. Eur J Esthet Dent. 2006 Apr;1(1):10-9.
Galip G. The science and art of Porcelain Laminate Veneers , London, Quintessence, 2003, Print
Ajay Juneja, Ceramic Veneers : Tooth Preparation for Enamel Preservation; Jan, 2016. www.styleitaliano.org
Ajay Juneja, Ceramic Veneers : No preparation and Minimal Prep Veneers ; April, 2016. www.styleitaliano.org