Esthetic and function rehabilitation

For the functional and aesthetic success of indirect restorations, a correct multistep protocol should start with planning of the treatment. A 37-year-old female patient came to our practice complaining about the unnatural appearance of her old prosthesis and seeking for a new, better-looking one. According to symptoms and clinical findings, a soft tissue management and build-up the teeth was evaluated to be necessary before replacement of the old prosthesis to achieve a wider and more harmonious smile. A combined approach was chosen. Our first step, before removing the pre-existing crowns, was to take an impression with an A-silicone (DMG A-silicone Honigum) to fabricate a temporary prosthesis in order to let the soft tissues heal (pink factor).

styleitaliano style italiano old ceramic dental prosthesis

Fig.1
Initial situation with the un-accepted shape and shade of the old prosthesis.

styleitaliano style italiano intraoral picture with old crowns

Fig.2
Intraoral initial situation.

styleitaliano style italiano lateral view showing old crowns and abutments

Fig.3
Side view.

styleitaliano style italiano close up of old dental prosthesis

Fig.4
Close-up showing chipping of the old prosthesis. Note the mono-shade crowns from cervical to incisal, which were missing texture on the labial surface of the teeth.

styleitaliano style italiano dual cure composite resin for core build up

Fig.5
After removing the old prosthesis, we needed to build up the teeth by using LuxaCore Z from DMG before the final preparation of the teeth.

dmg banner style italiano styleitaliano
dmg banner style italiano styleitaliano
styleitaliano style italiano injectable dental dual cure composite resin

Fig.6
After cleaning the teeth, etching was carried out for 20 seconds. Then a bonding agent (Ecosite Bond) was applied followed by LuxaCore Z to replace the missing tooth structure. This material has similar features to those of natural dentine and is easy to apply. Moreover, it has exceptionally high compressive strength for enhanced stability, and enhanced flow and handling characteristics which is why it was perfect for this situation.

styleitaliano style italiano multiple dental abutments

Fig.7
Teeth were prepared, and ready for precision impression.

styleitaliano style italiano positioning impression material inside impression tray

Fig.8
The impression was taken with a single step technique using DMG Honigum Pro Putty Soft and Light. The light body material is very flowable and able to fill all the space created by the second retraction cord.

styleitaliano style italiano injecting resin inside silicone key

Fig.9
A silicone index was fabricated using both a putty and a light body (DMG Honigum Pro Putty Soft and Light). To create a provisional restoration, LuxaCrown was placed inside the index key directly with the mixing tip.

style italiano styleitaliano dmg luxacrown
style italiano styleitaliano dmg luxacrown
styleitaliano style italiano positioning of silicone key for fabricating provisional prosthesis

Fig.10
The silicone key was tried inside the mouth before filling it with resin.

styleitaliano style italiano excess resin flowing out of silicone key

Fig.11
After placing the silicone index in the mouth and stabilizing it, excess material flows through the v-shape cuts on the silicone index. These cuts are very important and should follow the cervical embrasure anatomy to allow for easy cleaning and removal of the excess resin. Recommended time for removal is when the LuxaCrown excess enters the gel phase. At this time it’s easy to remove with an instrument or a microbrush. Then we should wait for complete setting of the material (around two minutes) before removing the silicone index.

styleitaliano style italiano raw provisional dental prosthesis

Fig.12
After removing the silicone index, the LuxaCrown can be polished with a polishing bur and paste.

styleitaliano style italiano final lithium disilicate restorations on printed model

Fig.13
Final prosthesis was fabricated using milled BL1 lithium disilicate blocks (Ivoclar Vivadent) by CAM technology (Sirona). Due to loss of a substantial amount of enamel of many teeth, partial and full coverage restorations (crowns and overlays) were fabricated instead of laminate veneers.

styleitaliano style italiano final dental prosthesis

Fig.14
Final situation. Due to the medium-low smile line of the patient, the selected finish line was juxta-gingival in spite of the thin biotype that slightly showed the dark core of the tooth, giving the grayish color you can see in this close-up view.

styleitaliano style italiano before and after new dental prosthesis

Fig.15
Before and after.

styleitaliano style italiano old unaesthetic dental crowns

Fig.16
Before, intraoral.

styleitaliano style italiano close up of new dental prosthesis

Fig.17
After, intraoral.

styleitaliano style italiano smile with old unaesthetic dental crowns

Fig.18
Smile before.

styleitaliano style italiano smile after new dental prosthesis

Fig.19
Smile after. The dentist and the patient were very happy with the final smile.

Conclusions

Although treatment planning and smile design are crucial to success in prosthodontics, the materials involved can really change the quality of a practitioner’s workflow. Bis-acryl resin materials such as DMG LuxaCrown, are an aesthetic, fast and easy solution to fabricate mock-ups and temporary restorations in the dental office. As presented in this article the build-up material LuxaCore Z, temporary material LuxaCrown, and the impression material Honigum from DMG are key in my everyday practice, starting from the aesthetic project validation, down through controlled preparation and functionalization.

Bibliography

1. Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations: Recommendations for success. J Am Dent Assoc. 2011;142(Suppl 2):20–4S.
2. Koumjian JH, Holmes JB. Marginal accuracy of provisional restorative materials. J Prosthet Dent. 1990;63:639–42.
3. Guess PC, Schultheis S, Bonfante EA, Coelho PG, Ferencz JL, Silva NR. Allceramic systems: Laboratory and clinical performance. Dent Clin North Am. 2011;55:333–52.
4. Kavoura V, Kourtis SG, Zoidis P, Andritsakis DP, Doukoudakis A. Full-mouth rehabilitation of a patient with bulimia nervosa. A case report. Quintessence Int. 2005 Jul-Aug;36(7-8):501-10.
5. Guess PC, Schultheis S, Bonfante EA, Coelho PG, Ferencz JL, Silva NR. Allceramic systems: laboratory and clinical performance. Dent Clin North Am. 2011 Apr;55(2):333-52, ix.
6. Rekow ED, Silva NR, Coelho PG, Zhang Y, Guess P, Thompson VP. Performance of dental ceramics: challenges for improvements. J Dent Res, 90 (2011), pp. 937-952.

style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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