Is There A Market For Natural Looking Restorations? By: Dr. Derek Gaudes, DMD

A comprehensive examination was performed to assess her total oral health needs. Upon examination of her entire dentition, numerous large failing restorations were found in the posterior teeth. Periodontal health was excellent. Her temporomandibular joints were healthy and occlusion stable.

At a follow-up appointment, the options to restore her teeth to ideal health were discussed at length. She decided to undergo a full-mouth rehabilitation starting with replacement of the six lower anterior veneers. The maxillary teeth are ultimately going to be replaced with natural looking PBM crowns. The mandibular posterior teeth will receive numerous PBM crowns and a bridge in the forth quadrant.

A diagnostic wax-up was performed for the mandibular arch. She was shown the aesthetic wax-up to confirm the proposed tooth shape and position of the lower anterior restorations before proceeding with tooth preparations.

The six lower anterior porcelain veneers were removed; preparations modified and refined and a full arch polyvinylsiloxane impression taken. Six temporary veneers were fabricated as one piece using a putty stent taken from the diagnostic wax up. The provisional veneers were bonded to the underlying tooth by etching the peripheral enamel and applying a single bottle adhesive to entire tooth and internal surface of temporaries. Dual cure resin provisional cement was used to lute the one piece temporary to the teeth. The temporaries would have to remain in place for five to seven months while awaiting the arrival of the definitive porcelain veneers.

The provisional veneers were removed by sectioning with a high-speed drill. A micro etcher was used to remove residual provisional cement and enhance the tooth surface prior to the bonding procedure. The porcelain veneers were tried in with various water soluble try-in pastes to determine the ideal shade for the luting resin. The porcelain veneers were luted with a single bottle adhesive, light cured resin, wetting & desensitizing agent and silane.

The maxillary crowns were adjusted for centric occlusion, lateral and protrusive excursions. At a subsequent appointment, eight chair-side fabricated provisional restorations were placed on teeth 5–12. The same technique was used from diagnostic wax-up to cementation of temporaries as was performed for the lower anterior teeth. With eight provisional restorations opposing the lower porcelain veneers, the envelope of function can be refined and perfected prior to placement of the definitive maxillary PBM crowns.

Once the eight maxillary crowns are placed, the mandibular posterior segments will be restored followed by the maxillary posterior segments. This sequencing will allow for the development of posterior crown anatomy that will work within the already established anterior guidance.

Honestly, I have never even considered doing something like this, so I never mentioned it to patients. I guess I’m too taken with magazine cover fake teeth, because that is what I believe the patient wants. I guess I need to stop and think about this next time I present a case. I need to mention this possibility to the patient, even though it is finally the patient’s decision.

Thanks for posting this beautiful case.

Glenn: I have planned to add a little flavor to the maxillary arch reconstruction as well. When I restore pairs of teeth (i.e. 8/9, 7/10, 6/11) I prefer the pairs to look like they are from the same “family” not “identical twins.”

Socalsam: The laboratory cost on the porcelain veneers was $725 per tooth in Canadian currency. That is probably somewhere in and around $475 in US funds.

Tle: “European style” treatment. How perceptive you are. My ceramist is from France and just loves doing this style of natural looking reconstruction.

This is an example that if we want the best, we have to pay for it (and the patient does too).

Hope to find a lab man some day with this kind of pride in his work. I would be more than willing to pay that fee for that quality of work.

Dr. Derek Gaudes graduated from the University of Manitoba in 1986. He maintains a private practice in Winnipeg, MB limited to Aesthetic Dentistry and Complex Rehabilitation for adults. Dr. Gaudes can be contacted by email at dgaudes@msn.com or by telephone at 204.885.8140. Dr. Gaudes would like to extend his gratitude to Mr. Olivier Tric of Olivier Tric Laboratory in Chicago, Il for his commitment to precision aesthetic restorations as handcrafted for this case. Dr. Gaudes and Mr. Tric offer advanced training for dentists and laboratory technicians on “How to Achieve Natural Looking Porcelain Restorations”.