Dental Asia November/December 2022

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CLINICAL FEATURE MOCK UP TRY-IN/TRANSFER The mock up was done using the impression from the first composite bonding. Specific parts were built up by wax, but reductions were also done for the planned smile. The proclination of the anterior teeth were considered and were mocked up with less material on the facial side and more towards the palatal area. The facial-incisal plane of the mock up is now slightly accentuated to give the effect of retroclination and to approximate the overjet of the anterior teeth to facilitate proper phonetics. A silicone stent was prepared using putty-wash technique, and then trimmed to the shape of the cervical scalloping of the teeth (Fig. 18). Transfer of the mock up was done by line etching the teeth with 37% phosphoric acid (Fig. 19), and then application of a bonding agent (Futurabond U, VOCO: Fig. 20) to all labial surfaces was done and cured after evaporation of the solvent; this is to facilitate good bonding to withstand some function for a week, but reassuring the removal process during the preparation phase will be easier as compared to a fully etched tooth. A self-curing, injectable temporisation material (Structur 3, VOCO) was injected into the silicone stent (Fig. 21) and then placed on top of the natural dentition, excess removed from the cervical area before removal of the silicone stent after four minutes (Fig. 22), then light-cured for bonding assurance. The surface oxygen inhibited layer was wiped off with alcohol and then the temporaries were adjusted as per the patient’s request. Final minimal polishing for gloss was done with a single-step polisher (Dimanto, VOCO) with smooth strokes under low speed with water cooling. Impression was taken after the final polishing procedure for the basis of the definitive composite restorations (Figs. 23-27). GUIDED PREPARATION THROUGH THE MOCK UP Preparation of the teeth were done after a week from temporisation. The plan was for a minimally invasive reduction as per patient’s request, and the target shade that the patient wanted was still B1 despite final shade matching being stable at B2. A reduction through the mock up was done at 1mm on the incisal and 0.5mm on the incisal and middle facial thirds (Figs. 28-29), no reduction was done on the cervical third. Fig. 18 Fig. 19 Fig. 20 Fig. 21 Fig. 22 Fig. 23 Fig. 24 Fig. 25 Fig. 26 Fig. 27 Fig. 28 Fig. 29 30 DENTAL ASIA NOVEMBER / DECEMBER <strong>2022</strong>
CLINICAL FEATURE Fig. 30 Fig. 31 Fig. 32 Fig. 33 Fig. 34 Fig. 35 Fig. 36 Fig. 37 Fig. 38 Fig. 39 Fig. 40 Fig. 41 Reduction through the mock ups showed that minimal to no reduction was done on the natural teeth (Figs. 30-31), so the surface enamel was only roughened with fine grit diamonds and abrasive disks. COMPOSITE BONDING TECHNIQUE Rubberdam isolation was done for optimum moisture control and bonding, the teeth surfaces to be layered upon were fully etched with 37% phosphoric acid (Fig. 32), then bonding agent applied on all etched areas (Futurabond U, VOCO) (Fig. 33). A palatal stent that was fabricated from the adjusted mock up impression used to facilitate the buildup of the palatal shell using a nano-hybrid pure-silicate based direct composite, incisal translucent shade (Admira Fusion, VOCO) (Fig. 34), interproximal shells were also built up using the same shade and material (Fig. 35), this is to facilitate an easier layering of the body shades. Layering of the body shade was done using B1 (Admira Fusion, VOCO) (Fig. 36), the blending of the layered body shade to B2 shade tooth structure is crucial, the B1 body shade should be tapered off properly and equally on contralateral teeth for proper cervical gradience and blending, the use of a nylon brush (Anterior Composite Brush, Smile Line) was used with a minimal amount of modelling liquid (Ceramage Modelling Liquid, Shofu), taking care not to use an excessive amount of modelling liquid as this can potentially create voids and therefore compromise the strength of the composite buildup. The incisal internal mamelons were shaped, leaving space for translucency and other incisal effects for optimal aesthetics. A thin layer of B1 shade was layered on the incisal edge to imitate the incisal halo, small incisal detailing was also layered using A2 shade (Admira Fusion, VOCO), this will render vertical lines inside the incisal translucency (Figs. 37-38). Multiple stains were applied to the various areas of the layered restoration; Blue on incisal areas to simulate incisal depth and translucency, blue on developmental grooves/fossa to increase the effect of depth in between the layered lobes, a combination of yellow and white on the mesial and distal lobes to increase value on those areas, and a combination of yellow and brown on some selected areas in the incisal to simulate chromatic irregularities, typically found on natural teeth (Final Touch Stains, VOCO) (Fig. 39 and 40), a cross-polarised photo shows the subtle effects that the stains (Fig. 41). DENTAL ASIA NOVEMBER/ DECEMBER <strong>2022</strong> 31
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Dental Asia November/December 2022

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