By Dr. Jason Olitsky
Do you want more predictable smile designs and more consistent results? Spend more time on the details of the provisionals. Good cosmetic dentistry CE should include time on the provisional restorations. The provisionals have the ability to serve as the prototype for the ceramic restorations, but too often they merely serve as a bandage to cover the preparation, with a promise to the patient that the ceramics will be perfect. The closer the provisionals come to the actual shapes and lengths of the ceramic restorations, the more predictable and consistent the results will be when performing smile designs. It begins with a mock-up at a diagnostic appointment. The more articulately we relay the tooth positions, shapes, and lengths of teeth to the laboratory technician from the diagnostics appointment, the more useful the wax-up will be at the preparation appointment.
Instead of just taking a preoperative impression and explaining in a laboratory prescription a few goals for the case, try providing an intra oral mock-up with composite materials before taking an impression. Make the goal for the mock-up to communicate midline, incisal edge lengths and inclination and buccal corridor position. This will make the mock-up a quicker treatment to provide. To make it a more practical procedure, don’t try to get too pretty with the mock-up. Once completed, take an impression of the mock-up and dental photography for the laboratory, and they will use your guide to help them create a more useful wax-up for the preparation appointment, like taught in our Clinical Mastery Series courses during Anterior Aesthetics Live.
Now that the laboratory has created a wax-up designed with the help of the mock-up, provisionals fabricated from the wax-up will be a lot closer to the desired final result. Starting with provisionals that do not need a lot of intra oral contouring saves time. While the mock-up does not need to be pretty, the provisionals should closely resemble the ceramic restorations. The best way to communicate small changes to the provisionals with the laboratory is to make those changes yourself, before taking an impression of the provisionals for the laboratory to follow. Change and measure lengths, correct any incisal canting, establish the shapes and embrasure forms. Dentists have the benefit over ceramists of being able to see the tooth shapes in the mouth and how the teeth interact with the face. Practice is the best way to get good at contouring teeth in the mouth. Understand the principles of smile design and the influence of the reflective and deflective areas of the teeth to the perception of overall tooth shape. Above all, make sure provisionals correct incisal edge canting and have correct facial planes. Incisal edge cant and deflective facial profile corrections are difficult to communicate with words and pictures and are often times duplicated in the ceramics. Don’t be afraid to schedule a second appointment to spend more time with the provisionals. Then give the provisionals a nice polish and glaze with Palaseal (Heraeus Kulzer) to give them a porcelain-like finish. Finally, take impressions of the provisionals and good clinical photography to share with the laboratory.