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CASE PRESENTATION: Smile Update: Maximum Results with Minimum Treatment

Categories: Restorative Dentistry

Author(s): TODD C. SNYDER, DDS, FAACD

Date: 02-17-2021 11:34:13 am


It is so rewarding to make a dramatic improvement in a patient’s smile with relatively conservative and economical treatment. With otherwise good oral health, a 47-yearold female presented unhappy with her smile. She was reluctant to show her teeth when she smiled because of the poor gingival shape that created a gummy smile, as well as a cosmetically unappealing crown on tooth No. 9. The patient decided, after being given all of her cosmetic options, to do laser-assisted gingival recontouring and to have the existing crown replaced.

Initial Appointment
At the next appointment, the patient was anesthetized and we took an over-impression with a stock tray and Template Ultra Quick Matrix Material (Clinician’s Choice). This would be used to fabricate the provisional.

After removing the crown, we took a base shade photo of the prep and surrounding teeth along with VITA shade tabs (VITA North America). This image will let the ceramist see the tooth shade prior to dehydration.

Next, I used a diode laser to perform a bloodless gingival contouring and troughing. This eliminated the need for cord or a hemostatic agent. We then took additional photos with the polar_eyes Cross Polarization Filter (PhotoMed), which eliminates unwanted reflections on the teeth from the flash. This image gives the lab an unobstructed view for enamel subsurface mapping of nuances and characterization.

For the definitive impression, I prefer to use a custom tray. With HEATWAVE thermoplastic moldable trays (Clinician’s Choice), we can easily achieve a custom fit. Aquasil Ultra Cordless material (Dentsply Sirona) was placed in the tray with tray adhesive, and we took the impression.

We fabricated the temporary using INSPIRE temporary material (Clinician’s Choice), and Cling2 temporary cement (Clinician’s Choice) was used to cement the provisional in place.

Seating Appointment
We received a beautiful zirconia crown from the lab, which was seated with Ceramir cement (Doxa Dental). Ceramir offers an alkaline pH and bioactivity for long-term antibacterial action and biocompatibility. Another plus is easy cleanup of the excess.

The patient was thrilled with the esthetics of her new smile.




GO-TO PRODUCTS USED IN THIS CASE

TEMPLATE ULTRA QUICK MATRIX MATERIAL

Specially designed for provisional fabrication, Template is an ultra-quick, ultra-accurate silicone matrix material that flows into embrasure areas and into the finest morphology to capture superior detail. Also ideal for the lingual matrix technique for Class III and IV restorations, the material sets in 30 seconds and, once cured to a rigid 68 durometer, releases easily and maintains its stable form.

CLING2
Cling2 is a zinc-oxide noneugenol automix temporary cement with a unique polycarboxylate resin in a paste-paste format. Ideal for cementing provisional crowns, bridges, inlays, and onlays, the cement mixes automatically to provide a bubble-free, 1:1 base:catalyst mixture. Cling2 contains unique properties that make it bacteriostatic, reducing gingival plaque retention and inflammation in the sulcus.
 
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