Chairside - Glidewell Dental Labs

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minimal-PREP Case Photo Essay – ARTICLE & CLINICAL PHOTOS by Michael DiTolla, DDS, FAGD – COVER PHOTO by Sharon Dowd 14 Minimal-Prep Case Photo Essay
have really come around to no-prep veneers. As our technicians and the ceramics have improved, I have been getting much better results on a much wider variety of cases. There are still those cases, however, where some minimal enamelplasty can make a big difference in final esthetics. I usually have a conversation with the patient to determine if they are set on no-prep veneers or open to minimal-prep veneers. It’s a little ironic because no-prep patients don’t want their teeth touched, but it would be impossible to ever remove the veneers without prepping tooth structure. I am comfortable with both and I welcome patient input when planning these cases. Figures 1-3: This 32-year-old female patient wanted to improve her smile but did not have much luck with vital bleaching. A previous dentist had placed some direct composite veneers on the upper and lower anterior teeth, but most had broken off or worn away. These photos are used to judge macroesthetic issues, such as smile line, and whether there are gingival issues that need to be addressed. Figures 4-6: The retracted views of her smile show there are small islands of composite still attached to the teeth in random areas. There is some composite on the lower teeth as well, but the patient can only afford to treat the upper arch at this time. These photos are used to evaluate esthetic issues related to the interdigitation of the upper and lower anterior teeth such as overbite, overjet and crossbites. Figures 7-9: The addition of a black background makes it easier to see specific esthetic issues. Tooth rotations, gingival embrasures, shade issues and incisal translucency are much easier to see when the lower teeth are not visible and the contraster is in place. Figure 10: It is not until you see this occlusal photo that you can begin to determine whether this is going to be a no-prep or minimal-prep veneer case. Since most dentists Figure 1 Figure 2 do not take photographs, they must wait until the lab pours the model and views it from this angle. Based on this view, we decided to do minimal-prep veneers. Figure 11: Based on Fig. 10, we decided minimal reduction was needed on teeth 7, 9 & 11. My definition of a minimal-prep veneer is one that requires enamel removal for optimum esthetics but exposes no dentin. Part of a minimal-prep veneer is patient approval for removal of the tooth structure. I’ve had many minimal-prep patients who wanted no-prep veneers. While it compromises esthetics somewhat, I cannot force the patient to value esthetics over conservation of tooth structure. Figure 12: Teeth 7 & 9 require facial reduction to improve the esthetic result of the final restorations, while tooth 11 only needs reduction to the distal third of the tooth. It is surprising how often the distal third of the canines have rotated facially, which throws off the overall esthetics of a smile. Ideally, the distal third of the canines should not even be visible from a straight on smile view. Figures 13-14: I had the laboratory make a putty wash reduction guide for me to ensure I would reduce the teeth only as much as needed. The lab has taken the study model and reduced it in the areas we agreed upon, duplicated the model, and then waxed it up to ensure they Minimal-Prep Case Photo Essay15
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Editor’s Letter Publisher Jim Gli
Page 6 and 7: Letters to the Editor “Dear Dr. D
Page 8 and 9: Contributors 6 Contributors Michael
Page 11 and 12: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 13: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 18 and 19: Figure 3 Figure 5 Figure 7 reduced
Page 20 and 21: Figure 15 Figure 17 Figure 19 is us
Page 22 and 23: Figure 27 Figure 29 Figure 31 thesi
Page 27 and 28: Incorporating Portrait PhotograPhy
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Page 56 and 57: I The Dangers of Denial am a dentis
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Page 63 and 64: Nevertheless, here are my steps to
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