One-on-One An Interview with Dr. Paul Homoly Simply Beautiful A ...

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A thin articulating medium (AccuFilm ® , Parkell; Edgewood, NY) was introduced between the posterior teeth without anterior restorations in place to evaluate the “occlusal lock.” (Note the provisional occlusal lock in Figure 12.) The anterior restorations were removed, since the platinum foil does not permit complete marginal seating of the restorations. The AccuFilm would mark centric prematurities and was left on the teeth for the ceramist to adjust during the finishing process (Figure 17). 11 A periodontal probe was used to verify the position of the gingival papillae at the proximal facial line angle of 3 mm incisal to the crest of the alveolar bone (Figure 18). This would ensure that a “black triangle” would not be created and that the gingival papillae would fill the gingival embrasure space completely. Figure 17: The maxillary bisque-bake try-in from the occlusal view after recording the first occlusal contacts with articulation paper. Finishing and Glazing The restorations were then sent back to the ceramist for finishing and glazing. Figures 19 through 21 show the finished Venus restorations for the case from various views. Note the natural appearance of the ceramic and how well the posterior zirconium restorations blend and match the feldspathic anterior restorations. Also note that the vertical dimension of occlusion, based on the unprepared second molars, was opened posteriorly approximately 3 mm. The second molars were left unprepared to preserve a reference to the preoperative position; they will be prepared and restored at a later date. Figure 18: The osseous crest is sounded to 3 mm at the facial proximal line angle. This verifies that the gingival tissue (papillae) will fill the gingival embrasure completely. Cementation and Delivery of Final Restorations The cementation process was begun with the maxillary arch. The maxillary central incisors were evaluated individually for marginal fit and together for the mesial proximal contact. Since these restorations were made of Venus feldspathic porcelain, the preparations were etched with 37 percent phosphoric acid for 15 seconds, thoroughly rinsed, and air-dried. A desensitizer (AcquaSeal B, AcquaMed Technologies; Chicago, IL) was applied to the preparations, and the excess was removed with a high-volume suction. A fifth-generation bonding agent (OptiBond ® Solo Plus, Kerr; Orange, CA) was applied to the preparations, air-thinned, and light-cured. A resin cement (NX3 Nexus ® Third Generation, Kerr) was syringed directly from its auto-mix syringe into the restorations, and they were placed on the preparations. The excess resin cement was removed from the margins, using an artist’s brush (#2 Keystone, Patterson Dental; St. Paul, MN). The adjacent lateral incisor restorations were seated on their respective preparations to ensure proper positioning of the central incisors, and the central incisor restorations were then “flash-cured” into position. This procedure allows most of the remaining resin cement to be cleaned away with a small scaler prior to the Figure 19: A full-arch occlusal view of the finished restorations. Figure 20: A full-arch facial view of the completed reconstruction in CO. 46 www.chairsidemagazine.com
completion of the cure. This “two-by-two” procedure is followed until all the anterior restorations on the maxillary arch are placed. Figure 21: A buccal view of the reconstruction in CO shows the Class I molar and Class II canine relationship, established by the ceramist. Figure 22: Retracted facial view of the completed fullarch maxillary reconstruction in CO, against the mandibular provisional restorations. The posterior zirconium restorations (Venus stacked on zirconium) were evaluated individually for marginal fit, and then seated to evaluate the collective fit. They were then cemented, one by one, using self-etching resin cement (Maxcem , Kerr). Figure 22 shows a retracted full-facial view of the cemented maxillary arch in CO, opposing the provisional mandibular restorations. The same protocol was used to cement the mandibular restorations, as previously described. 12 Figures 23 through 27 show the definitive restorations following delivery. Note the gingival health and natural appearance of the Venus restorations, even though the patient requested a “bright smile.” The gingival zenith positions above the maxillary anterior teeth are correct, the central incisor being slightly apical to the lateral incisor, and the canine at the same level or slightly apical to the central incisor. Note that the zenith position on the mandibular right central incisor is incisal to the left central incisor. The patient opted not to have this gingival zenith level surgically corrected since it did not show in his smile (see Figure 27). Figure 23: The mandibular reconstruction delivered and seated. Note the degree of occlusal accuracy when compared to Fig. 22. Summary This article has presented a detailed case report of full-arch corrective and restorative procedures using Venus porcelain. As noted at the full-smile final postoperative view, there is a natural texture, translucency, and cervico-incisal blend of color. The gingival papillae fill in the embrasure spaces well. The patient was pleased with the restoration and will enjoy it for many years to come. Acknowledgment The author would like to acknowledge the ceramic artistry of Vincent DeVaud, CFC, MDT, in the fabrication of this beautiful Venus reconstruction. To Contact Dr. Bob Lowe, call 704-364-4711 or e-mail boblowedds@aol.com. Figure 24: Full-arch occlusal view of the completed maxillary reconstruction. Simply Beautiful: A Venus Reconstruction of a Class II Malocclusion47
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Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 11 and 12: Dr. DiTolla’s CLINICAL TIPS - ART
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Page 18: If you have seen the marketing prop
Page 21 and 22: Interview with Dr.Paul Homoly - INT
Page 23 and 24: eplacing old crowns on 7 through 10
Page 25 and 26: ing the dentist quoting the fee. Wh
Page 27 and 28: the time, my grandfather, my mom’
Page 29 and 30: Now, when I teach this choice dialo
Page 31 and 32: But I understand Kevin has two boys
Page 33: PH: Right. After a while it just fe
Page 38 and 39: In the normal osseous crest, the
Page 40 and 41: 6. Facially, extend the preparation
Page 42: Low and high osseous crests can be
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Page 53 and 54: ❚❙❘ Abstract Low-level laser
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