Den-Mat Guest Editorial: A Quick, Painless Solution For Malaligned Teeth By: David Silber, DDS

Maybe you have a situation like this one. As you can see the maxillary anterior teeth are severely malaligned. In a consult the patient was presented with the treatment alternatives of orthodontics or a restorative intervention. The patient did not want braces, he desired a quicker solution––waiting two years for a new smile was unacceptable.

As part of our consult, I made a set of impressions and sent the casts to the Cerinate Smile Design Studio for evaluation to correct the malalignments with minimally invasive Lumineers by Cerinate. In the past, my experience working with the Smile Studio had been very positive. They are able to communicate what is necessary to fabricate minimal preparation Lumineers. If the case is not appropriate for Lumineers, they have provided alternative treatment plans. The Studio returned the casts indicating areas where tooth modifications were necessary to achieve a highly natural, esthetic result. They also returned a diagnostic wax-up of the completed case for evaluation. The patient was ecstatic with the proposed treatment.

Anesthesia was not necessary because the minor tooth modifications were only in enamel. The patient was even more pleased when they didn’t need to be numbed. Using the suggestions from the Smile Studio, I modified the tooth contours to achieve incisal alignment so the Lumineers could be fabricated. A final impression was made with a polyvinylsiloxane material (1st Impression). Because the tooth modifications actually made the teeth look better, there was no need for temporary restorations. And, since all modifications were only in enamel, there was no postoperative sensitivity. I provided the Cerinate Smile Design Studio with the final impression, opposing cast, bite and laboratory work authorization detailing the shade and design of the Lumineers. I also included the diagnostic wax-up. Actual chair time with the patient was less than 30 minutes.

Within days the Cerinate Lumineers were returned. I tried the Lumineers on the casts to evaluate fit and whether they had duplicated the diagnostic wax-up. Everything looked great. The patient came in for their new smile. The teeth were cleaned and the Lumineers tried in with Ultra-Bond Try-in Paste. The patient liked the shade and shape of their new smile. The Try-in Paste was removed from the Lumineers with Tenure S adhesive on Dab-eze sponges. Following the directions, the etched porcelain was treated with Porcelain Conditioner for 30 seconds, then rinsed and dried; Cerinate Prime porcelain primer was then applied for 30 seconds and lightly dried. The porcelain surface was lightly painted with Tenure S adhesive. Ultra-Bond Plus in an automix syringe was placed into the Lumineers and placed in a light tight box. Ultra-Bond Plus is a multipurpose dual-cure composite cement for any all-porcelain restoration.

The teeth were re-cleaned with pumice in a prophylaxis cup, rinsed and dried. The teeth were etched with Etch ‘N’ Seal for 15 seconds, rinsed and blotted dry with cotton pellets. Tenure Multipurpose adhesive has been very successful in my practice. Tenure A and B primer was mixed and painted on the etched surfaces in four to six coats for 10 seconds and air dried. Tenure S adhesive was painted on the etched surfaces. The Lumineers were gently seated on the teeth and tacked in place at the incisal edges with the 4mm tacking tip on the Sapphire Plasma Arc light for one to two seconds. All excess resin cement was removed with a Dab-eze sponge wetted with Tenure S. The 8mm tip was then used to final cure the Lumineers in place––facial, three seconds; lingual, three seconds for each of the Lumineers. The margins were finished and polished with finishing burs and the occlusion was checked and adjusted. The patient was very pleased with their new smile.

Dr. Silber received his DMD degree from the University of Puerto Rico in 1994. As a caring professional, Dr. Silber is committed to providing the highest levels of patient care, dental technology and innovative treatments available in his private practice. He currently maintains offices in both Dallas, TX and Puerto Rico.

He has lectured around the United States and the Caribbean for the local dental societies as well as private dental companies. His subjects cover cosmetic dentistry, air abrasion techniques and dental office management.

Dr. Silber’s skills have been widely recognized in the Caribbean as the dentist on staff for the chosen Ms. Universe 2001, and as a dental consultant for various health and beauty magazines in various languages. He is also a member of a team of doctors who promotes scientific research in the field of dental materials and their improvement. Dr. Silber’s articles have been published in an assortment of newspapers, magazines and journals.

Dr. Silber is also actively involved in his community and has coached Pee Wee Football for 12 years.