By Dr. Mike Smith
As clinicians, our patients don't always choose optimal and the most conservative treatment, which is why this case was such a great experience for me and my whole team. This patient desired to correct her crowding, by expanding her arch, with her primary goal of improving her smile by changing the shape, length and color of her teeth while still being conservative.
We initiated her treatment plan with basic disease removal leading to Invisalign. Pre-operatively, her arches were lingually inclined giving her a collapsed and deflective smile line. In order to idealize her arch form for conservative overall treatment, her curve of spee and curve of Wilson needed to be flattened and widened. We needed to re-established her canine guidance and balance out her occlusion time and forces. With her Invisalign orthodontic treatment completed, the challenge was how to get the aesthetic result she wanted with the prior worn teeth and restoration.
Tooth #7 had an endodontically treated tooth with a failing PFM crown. In order to maximize aesthetics, the Gold Dust Aesthetic Team and I discussed restorative materials. We chose to fabricate a "color correction coping" from e.max to blend perfectly with the minimal prep Emprethin veneers. By controlling the block out with an MO ingot allowed the ceramist to completely control color and opacity. She was deprogrammed and preadjusted with T-scan to remove any posterior interferences and balance her remaining occlusion. To get her approval on prescribed length, contour and function we mocked up with direct composite and designed her smile prescribing a wax up to be transferred to the mouth. I did temporize the patient utilizing Discus Perfect Temp by spot bonding and cementing with Ivoclar Telio cement. This allowed us to do a cosmetic/functional preview, based upon the wax up and test phonetics with the additional length and new position of the incisal edge.
Gold Dust fabricated the coping and Emprethins in approximately 2 weeks. I bonded the case with Variolink Veneer cement in a +2, for the coping first and then the remainder of the case we balanced warmth with 0 trans and -2 on the canines. The patient desired a bright shade of 020/010 that fits her cosmetic goal. The patient's occlusion was equilibrated with T-Scan to ideal and polished. Post-operatively, I fit the patient with a lower Invisalign retainer and a discluding/orthodontic retainer on the upper arch to facilitate long term retention and decrease any parafunctioning damage.
The patient is so pleased and it certainly shows.
