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).
Fig.1
Initial situation with the un-accepted shape and shade of the old prosthesis.
Fig.2
Intraoral initial situation.
Fig.3
Side view.
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.
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.
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.
Fig.7
Teeth were prepared, and ready for precision impression.
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.
Fig.10
The silicone key was tried inside the mouth before filling it with resin.
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.
Fig.12
After removing the silicone index, the LuxaCrown can be polished with a polishing bur and paste.
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.
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.
Fig.15
Before and after.
Fig.16
Before, intraoral.
Fig.17
After, intraoral.
Fig.18
Smile before.
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.
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