esthetic excellence
TRANSCRIPT
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Laura Kelly, CDTImmediate Past President and Accredited laboratory
technician, AACD
Betsy Bakeman, DDSAccredited Fellow and Chair, American Board of
Cosmetic Dentistry
M. Johnson Hagood, DDSAccredited dentist, AACD
Kenneth F. Hovden, DDSAccredited dentist, AACD
Nelson Rego, CDTAccredited laboratory technician, AACD
John Roberts, DDSAccredited dentist, AACD
Michelle Robinson WeberAccredited laboratory technician, AACD
A supplement to a Montage Media publication
Esthetic Excellence
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The Benchmark
of esTheTicsLaura Kelly, CDT*
HE BENCHMARK OF EsTHETiCs
F
or several decades, the American Academy o Cosmetic Dentistry
(AACD) and its members have pursued higher standards in dental
care. The dentists and dental technicians comprising the Acad-
emys membership strive not only to enrich their personal understand-
ing o cosmetic dentistry and their individual skills, but also to provide
a new benchmark in quality and esthetics or their patients as well. For
continued proessional growth, these practitioners rely on the counsel o
their colleagues and additional training they receive at the yearly AACD
scientifc session.
Many AACD members elect to urther distinguish their talents by
seeking accredited status rom the Academy. Accredited members
o the AACD have successully completed a rigorous testing process
that involves written, oral, and clinical requirementsmost specifcally
the completion and documentation o specifc clinical cases. As shown
in the Supplement that ollows, these cases encompass a variety otreatment modalities and must meet quality standards and protocols
as defned by the American Board o Cosmetic Dentistry.
The American Board o Cosmetic Dentistry does not endorse any par-
ticular clinical technique or style, nor does it endorse particular products or
materials. It is acknowledged that Accreditation success is not dependent
on the technique or the materials used, but on the excellence o the fnal
result. The applicants eatured herein have utilized Ivoclar Vivadent adhe-
sive materials and ceramics to support them throughout the Accreditation
process. Ivoclar Vivadent has a longstanding history among the esthetic
dental community not just or the quality o its restorative solutions, but
also or its ocus on educating dentists and ceramists on their optimal use
during daily practice. Ivoclar Vivadents sponsorship o this Supplement isanother example o the companys interest in supporting dental proes-
sionals within the Academy and those aspiring to achieve Accreditation.
On behal o the many technicians and dentists who rely on Ivoclar
Vivadent or its leading role in educating dental proessionals, we thank
you or your support. Together we oer our congratulations to the
AACDs latest group o Accredited Members, and or their continued
pursuit o excellence in dentistry.
* Immediate Past President, and Accredited Member, American Academy of
Cosmetic Dentistry; President, LK Dental Studio, San Ramon, California.
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PREFACE: The Bechmark of EstheticsLaura Kelly, CDT
The Road to Success:America Academy of Cosmetic Detistry Accreditatio
Betsy Bakeman, DDS
Comprehesive Restoratio of Aterior Crow Legth adProportio Usig a Direct Resi Veeer Techique
Kenneth F. Hovden, DDS
Esthetic Ehacemet of the Maxillary Aterior RegioUsig a Feldspathic Porcelai System: Laboratory Protocol
Michelle Robinson Weber
Laboratory Procedures i the Esthetic Restoratioof Maxillary Lateral Icisors
Nelson Rego, CDT
Esthetic Ehacemet ad Pathologic Occlusio Usig Six
All-Ceramic Crow Restoratios
M. Johnson Hagood, DDS
Aterior Esthetic Restoratio Usig a Direct ResiVeeer Techique
John Roberts, DDS
i
03
05
09
17
21
25
TABLE OF COnTEnTS
Sponsored by an unrestricted educational grant provided by Ivoclar Vivadent
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THE ROAD TO SUCCESS:Betsy Bakeman, DDS*
For practitioer wit a iteret i advacig teir educatio ad
ki i te area o etetic or cometic detitry, te America
Academy o Cometic Detitry (AACD) Accreditatio proce
provide a icomparabe ramework or growt, tudy, ad earig.
Te AACD Accreditatio proce i uique i tat it require detit
or tecicia to impemet wat tey ave eared ad to demotrate
a eve o profciecy a dictated by te America Board o Cometic
Detitry. Te amout o time ad eort eceary to attai te required
eve o profciecy varie baed o a idividua epoure to ad par-
ticipatio i advaced educatio, a we a i or er pre-eitig ciica
ki. Regarde o oe tartig poit, ucceuy acievig Accred-ited tatu i te AACD require time, dedicatio, ad true eort. By
competig ti proce, AACD Accredited member are abe to appy a
variety o etetic ki tat demotrate teir abiity to deiver optima
ora eatcare uig direct ad idirect retorative procedure.
Te Accreditatio tetig proce comprie tree part: a writte
eamiatio, ciica cae ubmiio, ad a ora eamiatio. Te
writte eamiatio tet oudatioa kowedge i cometic detitry
ad i admiitered at te AACD aua cietifc eio. Oce te
ciicia or tecicia pae te writte eamiatio, e or e a
fve year to uf te additioa requiremet.
Te ciica cae ubmiio ad evauatio orm te eart o te
tetig proce. Idividua demotrate, troug te ue o preop-erative ad potoperative potograpic documetatio, ciica ad
diagotic eceece i a pae o cometic detitry. Te protoco
dictate tat te cae tat are ubmitted oer a compreeive mi
o cometic treatmet outio tat kied detit ad tecicia
oud be abe to eecute we providig etetic detitry. Te fve
required cae type or ciicia are:
American Academy of Cosmetic Dentistry Accreditation
Bakeman 3
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EsThETIC ExCEllEnCE
Case Type 1. Ti preetatio ivove
i or more idirect retoratio witi te
maiary arc, treatig at eat te icior
ad caie. Te key to deiverig a opti-
ma cae preetatio i i eurig tat
te ciicia abiity to create a ope,
workig, ad ucceu rapport wit te
aboratory tecicia i evideced rom
tart to fi.
Case Type 2. Ti cae ivove oe or
two idirect retoratio i te maiary
aterior regio treatig icior, ad te
adjacet teet mut ave o idirect re-
toratio. Te caege wit ti cae
type i i evauatig te ciicia abiity to
matc te atura urroudig detitio.
Case Type 3. I ti preetatio, te ci-
icia demotrate a abiity to deiver
etetic reut via a fed partia de-
ture (FPD) or impat-upported retora-
tio. Te FPD oud cotai at eat oe
potic tat repace a maiary icior or
caie. I a impat retoratio i paced,
it oud icude a root orm impat ito
te maiary aterior edetuou pace.
A radiograp mut ao be ubmitted to
ow te pace or aiig toot prior to
impat pacemet.
Case Type 4. Ti cae coit o a
aterior direct rei (Ca IV or diatema
coure) retoratio, i wic te detit
abiity to bed compoite rei wit teatura detitio i evauated.
Case Type 5. Ti cae ivove i or
more direct rei veeer, wit te ciicia
treatig at eat te maiary icior ad
caie. Cae Type 5 tet te detit abi-
ity to create a optima etetic reut uig
direct compoite rei materia.
Matery o te fve required ciica cae
type utimatey aow ciicia to provide
teir patiet wit a broad rage o treatmet
outio. laboratory tecicia mut com-pete te frt tree cae type wit te addi-
tio o uppemetary bec potograpy. Te
ora eamiatio compete te proce, aow-
ig ciicia to review teir cae wit a team
o Accreditatio Eamier, deed teir treat-
met, ad provide outio to a ypotetica
ciica cae.
I ummary, Accredited member ave
demotrated a commitmet to te art ad
ciece o deiverig detitry tat traced
te cutomary boudarie o our proeio.
Patiet ca be aured tat Accredited
AACD detit ad tecicia ave demo-
trated a ig eve o ki ad epertie i
providig a variety o treatmet outio a
tey reate to etetic detitry.
Cogratuatio to te 20 ewy Accredited
member wo were oored ti pat year
at te AACD Aua scietifc seio ed i
new Orea, louiiaa:
Duae h. Beer, DMD
Jorge R. Baco, DDs
Tim M. Bradtock-smit, BDs
steve h. Brooker, DDs
David s. Eom, DDs
Ricard W. Featertoe, DDs
Micae K. Fort, DDs
Taaz T. Goodjo, DDs
M. Joo hagood, DDs
Emi hawary, DDs
Keet F. hovde, DDs
Ted J. Murray, DDs
neo A. Rego, CDT
Jo C. Robert, DDs
Micee Y. Robio Weber
Troy Ae scmeddig, DDs
Jo W. simmo, IV, DMD
Jey C. su, DDs
Wiiam h. swearige, DDs
scott R. Werkamp, DDs
I ceebratig idividua acievemet, te
Academy ao ceebrate te tadard o
eceece tat Accreditatio repreet.
Te idividua oored remid u tat we
mut a determiedy recommit to educatio
ad te puruit o eceece. We mut work
togeter to cotiue to eevate te tadardor optima etetic, te tadard or erv-
ig te bet iteret o our patiet, ad
te tadard or maitaiig etic o te
iget order.
.
* AACD Accredited Fellow; Chair, American Board of Cos-
metic Dentistry; Private practice, Grand Rapids, Michigan.
THe ROaD TO SUCCeSS
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U Drct R Vr Tcqu
CompRehensiVe ResToRaTionof anTeRioR CRown LengTh
anD pRopoRTionKenneth F. Hovden, DDS*
Dental patients who request esthetic
enhancement or require restorative
care can oten be managed through
multiple treatment options, each with
its ideal indications. While direct com-
posite resins are oten overlooked as
viable treatment alternatives in com-
plex cases, resin materials can allowthe clinician to modiy tooth color,
width, length, shape, and guidance,
with minimal preparation. This case
depicts the use o a direct resin tech-
nique used to veneer nine teeth in the
anterior maxilla, with optimal esthet-
ics and unction.
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EsthEtic ExcEllEncE
coMPrehensiVe restorAtion oF Anterior croWn Length
C
oemporary adeve dea e-
que eabe e a o eevey
repae e dered oo ade, o-
our, ad appearae. compoe re maer-
a ave ao mproved, aowg e ue-
u reorao o uo ad ee w
mma wear o e oppog deo; aura
ookg ee a ao be deveoped ug a
mped, mmay vave eque. Uke
mo proe ouo, oday ompo-
e maera (eg, 4 seao, ivoar Vvade,
Amer, nY) a be ued w predabe
reu o augme e eg oo ruure
w ay reverbe reu.1,2
C prtt
A 26-year-od mae pae preeed w ar-
e, type iii perodoa deae uve o
mupe 5-mm ad 6-mm poke, beedg
upo probg, ad eavy auu (Fgure 1
ad 2). care rk aeme wa odued
ad ormed e pae wa a oderabe
rk or are; e pae wa prerbed a a-
ome mou re (e, car-Free, Ora Bote
llc, Abay, OR) o redue are rk.
May o e poeror ee were o-reorabe ad requred erao. Mupe
ee ao requred dre reorao.3-6 Oe
ee a reque were ompeed,
wa eeary o purue e abrao o
dago mode ad urer poeror rea-
bao w e ue o mpa ad ed
proe. Eeay, e maary ae-
ror ee demoraed erproma are,
aa deaao w are, mapoo-
g, ad poor row wd-o-eg rao.
Trtt pl
te a reame pa oed o roo
pag a our quadra, oowed by
oroug ygee ruo ad mpeme-
ao o e are preveo program. no-
reorabe ee woud requre erao,
ad a dre re veeer prooo wa ed-
ued o reore ee #5(14) roug #13(25).
Reparao o e bua orrdor deey,
uee oo roao, ad mapooed
deo addo o reame o e area
o deaao ad are-ad-ore were
ao requred. Edodo erapy wa e-
eary or oo #15(27), oowed by a po
budup ad reorao w a u-overagerow. Ggva row egeg wa e-
eary e aeror egme o mprove e
eg wd-o-eg rao ad rae era
ue eve o be armoou w e e-
g eve o e maary rg aera or.
te eod pae o reame woud o
o abrao o mpa ct gude o dey
e poo o poeror mpa, or reao
o a urga gude, ad or mpa paeme
o repae ee #18(37) ad #19(36) pror o
er proe reorao.
Clcl prcdur
Premary mpreo were apured ad
mode were abraed. From ee mode,
a dea waup wa reaed baed o me
deg udamea. t wa aomped
w a eer waer ad de wa. A oe
mar wa e reaed o gude e dre
bodg eque.
Figure 1. Preoperave appearae demorae
ompromed ee ad uo bo e
maary ad madbuar rego.
Figure 2. Preoperave radograp evauao demorae erproma
boe o ad deay.
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te o ue wa r reooured ug
a Er:YAG aer oowg e admrao
o oa aeea. tue eve were mod-
ed o be armoou w oo #7(12). A
ue modao wa perormed or e
o ue oy ad ever eeded beow e
emeoeame juo. te aer-reaed
ue were aowed o ea or oe week.
sme deg wa baed upo e po-
o o e maary e era or, ad
ee #6(13) roug #8(11) were reaed a
e r reorave v (Fgure 3). Oe week
aer aer ue oourg, e dre veeer
prooo wa aed (Fgure 4 roug 7).
W puy a ad aa mare rom e
dago waup, area a requred eam-
eopay were deed o emae poe-
a ow roug. Area w deaao
ad are were removed, ad e ee weremro-eed o maa a mmay vave
preparao deg.
Oe ea oo wa prepared, e oe
mar wa ued o a e ompoe
budup proedure. te ee were eed
w a 35% popor ad maera or
30 eod, red or 30 eod, ad ar
dred. A deezg age wa apped or
30 eod o e de ad boed dry w
a mrobru. te bodg age (EtE, ivo-
ar Vvade, Amer, nY) wa e apped,
ar dred, ad ured.
W e puy mar pae, 4 seao
Bea Medum (ivoar Vvade, Amer,
nY) wa ued o rereae e gua ape
ad a edge o e oo. A A3.5 de-
ade wa e apped werever
de ruure were mg. A rb-
bo o ia cear (4 seao, ivoar Vva-
de, Amer, nY) wa e paed aroud
e de obe ad adjae o e a
edge o reae ome rauey e e-
ra ad aera or. ne, a A3 Eame
ade wa paed over e ggva rd
ad eaered o e mdde ad a
rd. te oo wa e broug o u o-
our w a Medum Vaue ade. Ea ayerwa ooured w abe brue dpped
modeg re ad ured or 20 eod. Fo-
owg e appao o a deoyg ouo
(e, Deo, Urade, sou Jorda, Ut), a a
ure wa perormed o ea oo or 40 e-
od pror o g ad pog.
A e ubeque v, e maary e
ae, aera or, ad era or ad
Figure 6. A rerao ord wa ued
e maary rg quadra, ad e dea-
ed oo ruure were prepared.
Figure 3. te maary aeror rego
wa edued or reorao ug a
dre ompoe re veeer prooo.
Figure 7. A oervave preparao
deg wa apped e maary
e quadra
Figure 4. Preoperave vew demo-
rae e preee o roaed aera -
or, mapooed ae, ad deay.
Figure 8. Faa vew o e ompeed
dre veeer. te madbuar ee
were edued or ubeque are.
Figure 5. Aoug e poeror ma-
dbuar deo requred erao,
uee agme wa ao pree.
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EsthEtic ExcEllEncE
coMPrehensiVe restorAtion oF Anterior croWn Length
dre veeer paed ug e aoreme-
oed eque. Bo r premoar ad
bua deaao bu were pooed
we e ar, o aa re were paed
o oea e deaao. te ma-
ary rg eod premoar ao ad a dre
re veeer paed o overome bua
orrdor deey.
te pae reured or addoa v o
e-ue e age, ompee a pog,
ad oba deve poograp ad rado-
grap (Fgure 8 roug 11). trougou
e proedure, e mporae o proper ora
ygee wa reored.
Cclu
t ae demorae me mprovemeug dre re veeer ad oervave oo
modao. A e proedure progreed, e
pae uderwe o oy a ee raor-
mao bu ao a ora ea awakeg. h
ome ygee mproved dramaay, a dd
perepo o overa aa ee. te pae
wa very peaed w ew me ad a-
paed ompeo o e poeror prooo
order o reur e pae o orma uo.
Rrc
1. Peyo J. Dre reorao o aeror ee: Revewo e a eque ad ae preeao. PraProed Aee De 2002;14(3):203-210.
2. Era R. Aredao a ae repor: Dreveeer. J come De 2002;17(4):36-41.
3. Bak J. creag beauy w your ow wo ad: Amped approa or dre veeer. J come De2002;17(4):49-56.
4. Ruea c. Fudamea o Ee. cago, il:Queee Pubg; 1990.
5. Gode R. Ee Dery. 2d ed. hamo,lodo: B.c. Deker i; 1998.
6. Dawo P. Evauao, Dago, ad treame oOua Probem. 2d ed. s lou, MO: cV Moby
compay; 1989.
* Adjunct Assistant Proessor o Endodontics, Uni-
versity o the Pacifc School o Dentistry, San Fran-
cisco, Caliornia; Clinical Instructor, Hornbrook Group;
Faculty, IDEA; Director, Bay Area Aesthetic Masters
Hornbrook Group Study Club; private practice, Daly
City, Caliornia. Accredited member o the AACD.
Figure 9. Pooperave oua appear-
ae oowg dre ompoe re re-
orao o e maary aeror deo.
Figure 10. te poeror deo were
eraed pror o mpa paeme ad
proe reabao.
Figure 11. Pooperave vew o e
aeror rego oowg predabe reo-
rao w a dre re veeer prooo.
I use a eathering technique when applying the A34 Seasons Enamel shade over the incisal layer aroundthe dental lobes. This allows me to create a more naturalshade transition in the middle and incisal thirds.
Kenneth F. Hovden, DDS
CLiniCaL Tip
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U fldtc prcl st:
Lbrtr prtcl
esTheTiC enhanCemenTof The maxiLLaRy
anTeRioR Region
Michelle Robinson Weber*
Patient confdence is oten dictated by
the esthetics o his or her smile. Dental
proessionals thus have a responsibil-
ity to ensure that any restorative treat-
ment given is o the highest possible
quality. The dental technicians role in
the restorative process is to provideesthetic restorations that blend in well
with the natural dentition. This pre-
sentation describes the use o a sys-
tematic laboratory abrication process
as means o delivering ull-coverage
crowns or seamless integration with
the patients natural dentition.
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EsthEtic ExcEllEncE
0 esthetic enhAnceMent oF the MAXiLLArY Anterior region
Apae me a ave a ga
mpa o or er quay o e. Bo
proeoa ad peroa reaop
a be eer eaed or dmed by e
odo o oe ee. te a ad
dea ea ave e aby o mprove
a pae odee ad, ereore, over-
a we-beg by provdg a mea o orre
e eg, ade, uo, ad ape o o
oy e dvdua ee, bu a ey reae o
ea oer e ere me. i e aeror
maa, ee goa are drey fueed by
e aby o e reorave eam o aeve
a armoou rao bewee e aura
deo ad ee dea reorao. A
ow e preeao a oow, we a
ge oo or ee requred, aege
maged, a a proper ade ma w be
ra o pooperave ue.
C prtt
A mdde-aged emae pae preeed w
e dere o revaze er me. te aeror
deo ad bee wor over e year ad
evera daemaa were pree (Fgure 1).
Addoa oo eg wa dered by e
pae e aeror rego, ombed w
daema oure, rageg, ad we-
g. te pae ao epreed a preeree
a er me maa a aura appearae.
te ue eg o bo era or wa
raed appromaey 1 mm ug a 810-mo ue dode aer (eg, Odyey, ivoar
Vvade, Amer, nY). Due o e preee o
eg reorao, e premoar ee were
prepared or u-overage reorao. te
ae ad era or were redued ug
more oervave eque o aommodae
ree-quarer veeer. lay e aera or
were prepared or u-overage row o oe
e daemaa ad repae e eg om-
poe reorao. A oa were broke o
eure e eram ad oro over porea
ayerg erpromay ad a e embraure;
pooperavey woud dever a more ba-
aed me.
A mpreo o e prepared ee wa
made, ad e ee were provoazed.
te mpreoad a reaed dago
ormaowa ubequey oveyed o
e dea aboraory or ue rougou e
reorao abrao.
Lbrtr prtclA edpa porea (e, iPs ile, ivoar
Vvade, Amer, nY) wa eeed or ue
a reraory eque. te poograp
ad mode o e provoa reorao
were o be oey oowed or ape, eg,
ad uo (Fgure 2 ad 3). te a
ad ao requeed a oa e ee,
e e ade o e prepared deo wa
uorm ad g oor. Addoa orma-
o reeved rom e a uded a a
oo ade w a g oor varao or e
ae. Appromaey 1 mm o a ra-
uey ad medum urae eure were
ao requred.
Rrctr mdlte abrao o mode or ae bega
w e pourg o a mpreo ug
de oe (e, Yeow Prma Rok De soe,
Wp M, louve, KY). te mode, w
e eepo o e workg mode, were a
aowed o arde. ne, ey were rmmed,
Once the restorations are refned and ready to glaze, I like tosteam the porcelain to remove any debris, and then thin theUniversal Glaze Paste with a Glaze Medium using a smallstain brush to provide the best possible luster.
Michelle Robinson Weber
LaBoRaToRy Tip
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ped a eeded, ad baed. te workg
mode wa e poured ug e ame de
oe ad a pre-dred bae pae (Zeer bae
pae, servo Dea, norbrook, il) w p
paed o e prepared mpreo. Oe e
maera ardeed, e mode wa removed
rom e mpreo. A ee oe wa
removed w a ae. te de were epa-
raed ug a damod d (#911h, Braeer
UsA, savaa, GA) ad rmmed w a #8
arbde bur. te mode were dupaed ad
e de were degaed pror o aruao
(srao, ivoar Vvade, Amer, nY) o e
aebow ad be.
prcl fbrctPror o budg ay par o e reorao, aa mar wa abraed rom e provoa
mode order o avod overbudg. Oe e
reraory de ad ooed rom burou, ey
were ready or a wa/oudao rg ug a
equa m o B1 ad A1 body porea o e
aa, a, ad oua urae o e de.
A Opa Ee 2 porea wa apped aroud
e marga area o reae e oa e
ee (Fgure 4). t ayer o porea were
paed o e waer-oaked de, e gy
apped o eure moo, eve overage o e
prepared area. te porea wa e oued
w ue paper o remove ay moure ad
paed o e porea urae (e, Programa
P100, ivoar Vvade, Amer, nY) or rg.
te de were red o 925c.
Oe rg wa ompee, e de were
aga oaked waer, e paed bak o
e dupag ray. Reerrg o e a
edge mar, e r budup wa perormed
ug a m o e ame B1 ad A1 porea.
t m wa bu up oo e a area o
orm e era obe. te premoar de
ruure wa bu up ad Oua Orage
porea wa apped o e era oa
area. Porea wa boed w a ue oremove ee moure. no odeg
wa perormed. A porea ke wa ued
o u roug e oa area o eparae
ea oo, ad e de were red aga o a
maurao emperaure o 915c. Oe oo,
e de were paed bak oo e dupa-
o ray ad oo e aruaor, e oed
o e a mar o very a e obe
Figure 1. Preoperave vew demo-
rae e preee o ee pag,
oo wear, doorao, ad or -
a row eg.
Figure 3. Oe e ee were prepared
ad mpreo raerred o e abora-
ory, a workg mode wa reaed o
eure deveopme o opma uo.
Figure 4. Porea budup wa om-
meed, ug e oe empae
o eabe pree reproduo o e
dered oour, eg, ad wd.
Figure 5. A ombao o B1 ad A1
porea (iPs ile, ivoar Vvade,
Amer, nY) wa ued o orm e er-
a obe pror o rg.
Figure 6. Evauao o e a budup
ad obe appearae oowg a
porea rg.
Figure 2. A dago mode w e
dered row eg ad ue oour
evdeed oowg aer reame.
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EsthEtic ExcEllEncE
2 esthetic enhAnceMent oF the MAXiLLArY Anterior region
ad o bee over-bu ad were e or-
re poo (Fgure 5 ad 6).
te de were aga oaked waer o
aep e e porea appao. te
body porea m wa apped a wa prev-
ouy o ompeae or rkage. te gua
ape o ee #7 roug #10 were bu up
o reae a ava o w o appy e
era ee (Fgure 7). te de ru-
ure wa bu up o e ae a we a
e premoar ug e body porea m.
sa wa ued e era oa area o
e premoar o reae more dep. A u
were eparaed w a porea ke, e
erproma area were oued up, ad e
porea wa red aga o 915c.
te red budup wa paed oo e
dupao ray ad oo e aruaor, epaed aga e a mar o eure a
e a edge ad obe were orre. te
oour ad a edge o ee #7 roug
#10 were orreed w Opa Ee 1 ad
Opa Ee 2 porea (iPs ile, ivoar
Vvade, Amer, nY). te lg Mammeo
porea wa ued o eae e obe dea
ad reae g fker o era ara-
erzao. A ma amou o Amber wa ued
or addoa araerzao (Fgure 8). te
porea wa e red aga a 915c.
te ooed de were paed o e ray
ad e oour were evauaed ug e
a mar. A mro damod d wa ued
o remove a ma amou o ee pore-
a rom e mea ad da edge pror o
oug. Foowg a evauao o oor
ad ee (Fgure 9), e a oour wa
reaed, aerag Eame 1 ad Ee 1
ad 2 (iPs ile, ivoar Vvade, Amer,
nY) over e ere urae o e ee. te
gua ape were ompeed e ame
wayaga, keepg w e orm o e
mar w e eepo o ompeao or
rkage. A ma amou o neura Eame
wa beaded aro e a edge wa bru o reae ao w e ed
porea (Fgure 10). t bru eque
eabed e abrao o reed reorao
a requred mma oourg w a bur.
te ee were eparaed w a porea
bade, ad a ma amou o porea wa
added o e oa area. te porea wa
e red oe more.
Figure 10. Eame ee were added o
e gua ad aa urae, ad are
wa ake o ree e reorao ug
a bru eque.
Figure 11. Pooperave vew o e a,
gazed reorao. noe e oa
e ee ad aura rauey
aeved ug e reraory eque.
Figure 12. Pooperave appearae
demorae armoou egrao ad
a aura, eke appearae.
Figure 7. te gua-a ape o
ee #7 roug #10 were bu up o
aow ee era ee.
Figure 8. coour ad a edge
were orreed, ad a lg Mammeo
porea wa ued o reae fker o
era araerzao.
Figure 9. lg rauey ad oor
ee were areuy evauaed pror o
a oourg.
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Cturte ooed reorao were ea red o
e mode dvduay, begg w ee
#8 ad #9 order o maa e orre
mde. te porea wa marked w mark-
g ape ad ay eavy oa area were
reeved w a damod bur. Ea reorao
wa paed e ray oe a a me, ad e
oa were adjued aordgy. i add-
o o ug aruag ape, ea reora-
o wa red w myar rp a we. te
adjae ee were removed ad paed o
e ray o very a oa aga. Fay, a
pee were red ogeer.
te ompee mode wa paed o e
aruaor, ad ay eeary adjume
were made or er reao. Proruve ad
ae moveme were ao eked, ad
a oourg wa aeved by ug a om-
bao o a #850 damod bur ad mrod
(Braeer UsA, savaa, GA). Fa mor-
poogy wa reed ug a fame-aped
damod bur ad perkymaa were reaed by
gy weepg e bur orzoay aro
e urae.
fl glzte reorao were red o 830c ad e
e o oo. A damod-mpregaed wee
wa ued o gy ree e gazed urae
ad area o e reorao a woud o-a e pae p ad reae aura wear.
Fay, a Robo bre bru ad a medum
porea pog pae were ued o brg
e porea o a medum uer.
te reorao were eam eaed ad
dveed ug ga bead a 80 p. Ay
remag porea aroud e marga
area were removed w e mpregaed
rubber wee pror o g o maer de.
Oe e reorao were eaed o e
maer de, e marg were eked
uder magao. te maer de were
e paed bak o e dupaor ray ad
a reorao were areuy paed; ma
adjume were made o e oa a
eeary. lay, e reorao were o
e od mode, a w me e marg,
oa, ad ouo were vered oe
more. A reorao were re-poed w
a bre bru ad pog pae o e
ay area a ad bee adjued (Fgure 11).
Pror o devery o e ae, e ago ur-
ae o e reorao were gy ad-
baed w 50 m aumum ode, e
eed or oe mue ug a eram ydro-
fuor porea e. tey were red w
waer, paed a eurazg ouo or
30 eod, oaked a up o aoo a
urao eaer or a addoa 5 mue,
ad ar dred. te ere ae wa e evau-
aed, paked or devery, ad emeed by
e a pror o oua adjume a
eeded (Fgure 12).
Cclu
By dgey oowg ea ep o e rea-
me pa, e reorave eam wa abe o
gay mprove e pae quay o
e. Durg abrao, areu aeo mube pad o dea o oor, oour, ad ape.
takg are o aommodae or porea
rkage ad ouay very , e abora-
ory ea may provde ee reora-
o a bed eamey w e aura
urroudg deo.
* Dental technician, CMR Dental Laboratory, Idaho Falls,
Idaho. Accredited member o the AACD.
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EsthEtic ExcEllEncE
4 bALAncing siMPLicitY AnD VersAtiLitY
bALAncing siMPLicitY
anD VeRsaTiLiTy
After successful tooth replacement with an IPS
e.max bridge.
Before
Case 1Dr. Nick Addario, Chula Vista, CA.
Mr. Andre Michel, Dana Point, CA.
Case 2Dr. Michael R. Sesemann, Omaha, NE.
Mr. Lee Culp, Bradenton, FL.
After placement ofan implant-supported IPS
e.max crown restoration.
Implant components
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With IPS e.max, dental professionals have a system for fabricating either lithium dis-
ilicate, high-strength glass-ceramic or zirconium oxide restorations. Its clinical perfor-
mance combines esthetics and strength for any region of the mouth, enabling clinicians
to provide their patients with beautiful, natural smiles. The ability of dental technicians
to achieve a predictable shade match in even challenging combination cases makes IPS
e.max a valuable treatment option for numerous AACD members and alumni.
Case 3Dr. Tom Trinkner, Columbia, SC.
Mr. Matt Roberts, Idaho Falls, ID.
After placement of IPS e.max lithium disilicate
and zirconia restorations.
Before
After esthetic replacement of gold intracoronal
restorations with IPS e.max inlay/onlay.
Before
Case 4Edward Lowe, Vancouver, BC.
Mr. Nelson Rego, Santa Fe Springs, CA.
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EsthEtic ExcEllEncE
6 Anterior Aesthetic restorAtion Using A Direct resin Veneer techniqUe
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i t ettc Rtrt mllr
Ltrl icr
LaBoRaToRypRoCeDURes
Nelson Rego, CDT*
While creating esthetic ull-mouth rehabilitations
can be an exhilarating experience, it is single-
tooth replacement that presents a greater technical
challengeand ultimately, rewardto the ceramist.
Successully blending a single restoration with the
adjacent tooth structures requires not only ones abil-ity to identiy the innate qualities o the natural tooth,
but then to imperceptibly mimic them in dental ceram-
ics. This situation presentation details a case where a
severely discolored lateral incisor was replaced with
a laminate veneer in order to provide a harmonious,
esthetic result.
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EsthEtic ExcEllEncE
8 LAborAtorY ProceDUres in the esthetic restorAtion oF MAXiLLArY LAterAL incisors
Laboraory ea are aeged
o repae aura ee o a day
ba. Furer ompag e arge
o rereae e mupe ade ad uae
o aura ee va a porea medum e
eed o preey ma e eg deo
we reag oy oe or wo ee w e
ee rego. today dea maera ave
gve a ad ea a arge array o
opo or reorg e aeror ee; ee
ude eram maera a mm eame
bo wear reae ad appearae. t
ae preeao demorae e abora-
ory prooo ued or e reorao o ae-
ror aera or w ureored ee ur-
roudg e reorao.
C prtt
Clcl etA 38-year-od emae pae preeed w
a eg porea veeer o oo #7(12)
(Fgure 1). te pae ad weed er ee
ug a a-ome yem ad, we e wa
aed w e eg beaed reu,
a ade drepay wa evde w
e aeror deo. Aoug orodo
reame wa preeed a a opo o or-
re e pae oo agme, e pae
wa aed w e mor magme
pree. her prmary oer wa abou e
ade o e ge aera, ad a porea
amae veeer wa eeed o repar e
eg ee.
Oe e a-ome weg prooo wa
doued, ade ormao wa apured
ad raerred o e aboraory (Fgure 2
roug 4). te abume oo wa e pre-
pared w a amer marg, ad e prepara-
o wa poed o eure emao o ay
arp e age. te provoa reoraowa abraed ad eaed, ad mpreo
were orwarded o e aboraory o a-
ae abrao o e deve proe.
Lbrtr prtclA ca iV de oe wa poured ad aowed
o arde or 24 our. careu aeo wa
Figure 2. te pae wa rued o eae a-
ome weg order o eure aurae ade
daa or abrao o e porea veeer.
Figure 1. Preoperave vew demorae door-
ao oo #7 ad, ereore, a uee ade
ma e aeror rego.
Figure 4. coer evauao o e doored aera
or demoraed e ereme ade varao
evde a ge oo.
Figure 3. te eram wa aeged o rereae
rauey ad uer o e aura deo ug
a predabe eque ad maera prooo.
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pad o e waer-powder rao order o
eure proper epao. te workg mod-
e were abraed ad moued o a ar-
uaor; e approved provoa reorao
were ao moued o e oppog mode.
A mar wa reaed ad ued o evauae
e aa ad proma reduo. te de
were areuy rmmed, ad a uderu
were boked ou w a uderu wa
maera. A u-oour waup wa e re-
aed (Fgure 5). A me, e oa
were waed o pae, ad e marg
were eaed w a mma rkage marg
wa (Fgure 6).
te waed amae wa prued ad
veed ug e peed pre eque,
ad preed iPs Empre Ee (ivo-ar Vvade, Amer, nY), ug a
EOc-1 igo (Fgure 7 ad 8). t go
wa eeed beaue o opa proper-
e ad g opay, w woud oea
e uderyg ade o e prepared oo
ruure. Oe e amae wa ooed
ad dveed, wa evauaed or ad
ayerg ommeed.
prcl Lr prcdurFoowg areu evauao o e dga
ade map ad preoperave poograp, e
porea budup wa u bak o aow e
auor o reae e may-aeed uae
a woud be requred o eure a aura-
ookg egrao. A oudao bake wa
readed w a ma amou o a ad gaze
pae, ad red a 770c. te amae wa
ayered w ia We ad Bamboo pow-
der (iPs Empre, ivoar Vvade, Amer,
nY) o reae e ee dpero o oor
a were pree e aura deo, ad
red a 840c. te amae wa eked w
e mar o eure a e ee were
e proper poo, ad a a ayer o Mt
a wa added o reae e raueya wa o eary demoraed by e au-
ra deo.
evlut, Ctur, d stte amae veeer wa emporary
emeed o e oe de ug syemp.k
(ivoar Vvade, Amer, nY) o aae
Figure 8. te amae veeer wa bu o oour
o e workg mode.
Figure 6. te preparao wa evauaed ad
boked ou a eeded.
Figure 5. te dered oo oour wa waed up
o e workg mode o eure proper wd-o-
eg rao pror o porea ayerg.
Figure 7. te a ubak proedure wa
aed o eure deveopme o ee
a rauey.
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EsthEtic ExcEllEncE
0 LABORATORY PROCEDURES IN THE ESTHETIC RESTORATION OF MAXILLARY LATERAL INCISORS
a oourg. Varou damod ad rub-
ber wee were ued o provde a ee
urae uer, w are ake o e refe-
ve ad defeve area. te mar o e
approved provoa reorao wa ued o
eure a e a oour o e deve
reorao oey maed oe ommu-
aed by e emporary. te amae wa
gy aed ad baked oe. te a po
wa aomped ug a o bre bru
ad pae o aeve e prerbed go.
te reorao wa reured o e a,
were wa peed or ad ade o
e mode. te provoa wa e removed
ad e preparao wa eaed w or-
ede ad red. A re eme maera
(Varok Veeer, ivoar Vvade, Amer,nY) wa apped o e era urae o e
amae. te vaue adg o eme
wa a bee mag e ge-oo re-
orao o e adjae deo. te veeer
wa pooed, ee eme wa removed,
ad e reorao wa po poymerzed w
a 2-mm akg p. Ouo wa vered,
adjume made a eeary, ad a pore-
a pog k wa ued o reder e a
appearae o e reorao oowg de-
ve poymerzao (Fgure 9 ad 10).
Concuson
Mag a ge amae veeer o a pae
eg deo a ead o a g eve o a-
ao, e ae e aboraory e-
a aeged o reae a reorao a
bed mperepby w e aura deo.
A preed eram wa eeed aordgy,
baed o e go aby o dever opmaopay o mak e uderyg ubruure,
w a aura uer ad a rauey.
* Laboratory Technician, Santa Fe Springs, California.
Accredited member of the AACD.
Using a Sil-Tech matrix, I can inject wax into the prepa-
ration models and veriy i sufcient reduction is present
prior to beginning the abrication process, reducing the
need or remakes and eliminating potential error.
Nelson Rego, CDT
laBORaTORY Tip
Figure 10. noe e armoou egrao ad
aura-ookg ade ma aeved.
Figure 9. Pooperave aera vew o e deve
reorao oowg eme eaup.
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U s all-Crc Cr Rtrt
esTheTiCenhanCemenTanD paThoLogiCoCCLUsion
M. Johnson Hagood, DDS*
All-ceramic restorations such as IPS
Empress (Ivoclar Vivadent, Amherst,
NY) enable clinicians to predictably
and successully address their patients
increasing esthetic expectations. The
ollowing presentation demonstrates
a clinical protocol used to place IPSEmpress restorations in a patient
with compromised anterior esthetics
and wear. The provisional restora-
tions served as a trial therapy that
enabled the clinician to resolve the
esthetic expectations o the patient as
well as the occlusal concerns present.
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EsthEtic ExcEllEncE
2 esthetic enhAnceMent AnD PAthoLogic occLUsion
Se e me o er roduo o e
dea dury ad proeoa, iPs
Empre (ivoar Vvade, Amer, nY)
a-eram reorao ave oered a ew
dmeo aeror reorave dery.
We provdg ee w opa ara-
er mar o oo eame, iPs Empre
row are ompoed o a omogeeou
eue-baed eram, w aer g
ke a aura oo ad eure a ee re-
orao bed w e adjae deo.
Reorao abraed iPs Empre mae-
ra eb e-ke rauey a we. i e
ae a oow, iPs Empre u-overage
row w be ued o mprove e appear-
ae o e pae me we reorg er
o paoog ouo.
C prtt
A 30-year-od emae pae preeed or
ee eaeme o er maary ad
madbuar deo (Fgure 1 ad 2). c-
a eamao reveaed e preee o a
PFM row o oo #9(21), daemaa e
maary ar, ad g o moderae wear o
e a urae o e madbuar or
(Fgure 3 ad 4). te pae wa ee-
e perodoa ea. te pae keea
reaop ad a ca iii edey ad e
madbuar or were reroed. terewere o abe odg oa bewee e
ower a edge ad gua urae o
e maary or.
te oao o e wearpredomay o
e aa urae o e madbuar or
wa dave o oo o ourrg durg
uoa moveme o e madbe. tra
erapy ad evauao woud u be ee-
ary o deerme oua orreo woud
reove e paer o wear o ee ee.
te ca iii keea edey ombed
w e oo-ar drepay o e ma-
ary ar reaed a pa o oure a ge-
eraed eeve roa ore bewee e
gua urae o e maary or ad
e oaa urae o e madbuar -
or. A oervave approa o reame
woud uze orodo erapy o aae
a ee oure pa o mamum eru-
pao a dd o reae premaure oadg o
e ee. however, e pae, duy ormed,
deed orodo reame. A reorave
opo a woud erve o addre bo e
uoa ad ee oer voved por-
ea reorao o e maary aeror
ee. A ee pa o oure o mamum
erupao woud be aaed by oow-
g e gua urae o e aeror ee
o aommodae e pae madbuar -
or durg uo. A eodary uoa
goa o reame woud be o reae abe
er op o a ee.
Trtt squc
A dago workup wa abraed; wa o-
rmed a bo e ee deee ad
oua probem oud be reoved roug
e paeme o u-overage reorao
o ee #6(13) roug #11(23), ad oua
equbrao. iPs Empre wa eeed a ereorave maera o oe, o oy or
ee quae bu or ow wear poea.
te provoa reorao woud be ued a
a empae or dreg reame ouome
eeay, poeay, ad uoay.
A vauum-ormed empae wa orued
o e dago a or ue a a reduo
gude durg preparao ad or abrao o
e provoa reorao. A oua de
wa ao abraed o ad pove eag o
Figure 1. Preoperave vew o daemaa
ad a edge poo o e maary
aeror ee, w reaed darmoy.
Figure 2. We e ggva areure
wa ymmer, e pae me wa
o eeay peag.
Figure 3. Oua vew o e maary
ar preoperavey reveaed e PFM
row o e maary e era or.
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e empae o a workg mode durg d-
re abrao o e provoa reorao.
tee #6 roug #11 were prepared o-
veoay, eep a mma oo ru-
ure wa redued e guum area ad
gy more reduo wa perormed o
e a wo-rd o e gua urae
order o oow em ad u beer aom-
modae e eveope o uo.
te row o oo #9 wa r removed, ad
e gro reduo o e oer preparao
wa perormed w damod bur. Rerao
ord wa paed ea uu, eavg 0.2 mm
o 0.5 mm o oo ruure vbe bewee
e marg ad e ord. te preparao were
e reed w e damod bur ued
a md-peed adpee. Foowg pog o
e preparao o emae ay urae rregu-are, agae mpreo were made o e
maary ar ad mmedaey poured w a-
eg dea paer.
idre provoa reorao were pro-
eed ary, rmmed, ad red o per-
m adjume o ouo. Equbrao wa
azed ad uded e eabme o
approprae aeror gudae. te provoa
reorao wa e eparaed o dvdua
u ad poed w a Robo bre bru.
te provoa reorao were emeed
ad e a mpreo were ake e o-
owg week (Fgure 5).
A e a mpreo appome, e
pae provded eedbak w regard o
e ade, oour, poe, omor, ad
ee o e provoa reorao. t
ormao wa oveyed o e dea abo-
raory o ad e abrao o e deve
reorao. A agae mpreo o e
maary ar w e eaed provoa re-
orao wa e ake; woud be poured
oe ad moued aga e workg
mode o a aruaor: 1) o gude e opma
ouo o e provoa reorao ad 2)
o ad e aboraory ea predaby
reprodug e dered ouo, oour,
ad a edge poo e deve reo-rao. Foowg e ompeo o a mpre-
o makg, e provoa reorao were
reemeed ad e pae wa eued.
Lbrtr itruct
A work order aompaed by a ee
ek, oor mappg, preoperave ad
provoa mage, a o e dago
Figure 5. te provoa reorao eabed e
pae o provde eedbak o ee, , u-
o, ad poe.
Figure 4. te PFM row o oo #9(21) rered
aura g ramo aroud e ggva marg.
Figure 6. Vew o e iPs Empre
a-eram row eaed o e mode
pror o ry ad emeao.
Figure 7. Pog up ad po were
ued or a pog, ad e reora-
o a uer wa reaed.
Figure 8. Oua vew o e iPs
Empre row pooperavey. Mma
oua adjume wa eeary.
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EsthEtic ExcEllEncE
4 esthetic enhAnceMent AnD PAthoLogic occLUsion
workup, ad provoa reorao were e
o e dea aboraory. tee daa woud be
eea eurg e dered reu w
e iPs Empre row.
f
te row were peed upo er reur
rom e dea aboraory ad were we-adaped
o e mode (Fgure 6). te aa de abraed
e aboraory aga a moued mode o e
provoa reorao preey aga e
aa oour o e deve a-eram reo-
rao. te era urae o e iPs Empre
row ad a uorm roed appearae da-
ve o we-eed urae.
A e devery appome, e paewa aeezed, e provoa reorao
were removed, ad e ee were eaed.
te row were red w Varok ii try-
i pae (ivoar Vvade, Amer, nY). te
pae wa gve e opporuy o ae
e reorao ad e approprae eme
ade (e, rapare) wa deermed.
te row were e eaed ad eed
w 37.5% popor ad ge e o or
oe mue ad e red. t proe
removed ay urae oamao ad ad-
ed e porea urae, w reaed eeay o a ae oupg age. A rey
med ae oupg age wa apped o-
owg dryg order o reae e bod
reg bewee porea ad re eme
ad o dereae mroeakage.
A ee o be boded were eaed ad
red, ad a rerao ord wa paed ea
uu o eure a dry, uoamaed ed.
te ee were eed w 37.5% popor
ad ge or 15 eod, red, ad e we. A
weg age (eg, tubud Red, Goba De-
a, Bemore, nY) wa apped o we ad d-
e e eed urae. De prmer were
med, ad ve o eve oa were apped o
ea preparao. Oe uy dred, e prepa-
rao were g ured or 30 eod per
urae. Pre-Bod re (Bo, saumburg,
il) wa apped o e preparao. trapar-
e-aded dua-ure eme (eg, Varok ii,
ivoar Vvade, Amer, nY) wa med ad
paed ea row. te row were eaed
ad ea wa po-ured e eer aa
urae w a 3-mm urg p.
Ee eme wa brued ad foed
away, ad a urg wa aomped w
60 eod per urae or ea oo. Fur-
er eme remova wa aomped uga h6/h7 aer ad Bard Parker #12 bade.
te erva ad erproma urae were
ed ug damod g bur ad
arbde g bur w a ar-waer m.
A marg ad oo urae were areuy
peed or overag ad rouge ad
were e poed (Fgure 7 roug 10).
Addoa reame woud o o mor
reorave are, roue eamao ad
propya, ad moorg o oo wear.
Cclu
te ee reu were very ayg.
By muaeouy addreg e pae
ee ad uoa oer, a ueu
og-erm progo oud be eured.
* Private practice, Vero Beach, Florida. Accredited mem-
ber o the AACD.
Figure 10. Vew o e pae me oowg
reame demorae mproved proporo ad
armoy w er p.
Figure 9. Pooperave vew o e eaed
ee aeved roug e iPs Empre row
ad er egrao.
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U Drct R Vr Tcqu
anTeRioResTheTiC
ResToRaTion
By challenging clinicians to deliver
esthetic restorations using a vari-
ety o restorative materials, orward-
thinking dental proessionals are
exposed to an expanded armamen-
tarium. O the case types required or
accreditation, the delivery o natural-
looking direct resin veneers in theanterior region represents a level o
mastery dierent rom any other type
o skill demonstrated in the opera-
tory. This presentation demonstrates
the use o composite resins to create
natural, lielike results using a direct
chairside technique.
John Roberts, DDS*
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28/326 Anterior esthetic restorAtion Using A Direct resin Veneer techniqUe
EsthEtic ExcEllEncE
Ee dery demad a era
eve o maery we ug a varey o
reorave maera order o oba
e dered a reu. sk preparao
deg ad emeao o porea veeer
aoe are o e oy quaao o a good
ome de. i addo o e maery
o dre porea reorao, ompo-
e epere rema a eeary k e
armamearum. Very ew de deveop e
k ad e ar o e dre ompoe e-
que or e purpoe o veeerg or more
aeror ee. For a majory o de, more
predabe, ee reu a be obaed
eaer ad aer w porea reorao
(eg, iPs Empre or iPs e.ma, ivoar Vva-
de, Amer, nY). We ee reame
ouo oe a or e ue o dre reo-
rao, ere are eray dao or dre
prooo. tee may ude (bu are o m-
ed o) addreg ee oer youg
pae, reame o pae wo w o
avod aggreve oo preparao, or pae
eed o raoa maera durg mud-
pary prooo. Uderadg ompoe
re ad e aoaed ayerg eque
we eoug o bok ou ad deveop o-
e ade, rauey, ad araerzao
w eray provde a opporuy o reae
auray udeeabe reorao a a aer-ave o porea veeer.
C prtt
A 32-year-od emae pae preeed or me
eaeme (Fgure 1). A a eamao
w eeary radograp ad a proe-
oa eag daed a o o or ard
ue paoogy were evde. Aoug e
pae ad prevouy udergoe orodo
reame (e, ivag, Ag teooge,
saa cara, cA) addo o ee row
paeme, g, ad roue are, ca i
ouo ad ca iii keea edee
remaed evde (Fgure 2). Mma, ay,
wear paer eed e eame. Fuo-
ay, aaory gudae wa evde durg
rg, e, ad proruve euro. no ba-
ag or workg ereree were oed
e poeror rego.1,2 no ory or ompa
o emporomadbuar dorder, pa, poppg
or rep upo mamum opeg, or aera
or proruve euro were oed (Fgure 3).
Faa ymmery wa evde, w o mde
. A md a wa pree o e e de,
w ow ue e ggva areure.
sor era ad aera or reued a
revered me e ad poor ee propor-
o (Fgure 4). te bua orrdor appeared
aaory (Fgure 5). te pae dd o ee
omorabe w e we ad brow po
vbe o e aeror deo, ad dered
greaer a eg, mproved poe,
ad eaed ee.
te pae perodoa ea wa ee-
e. too #13(25) wa reored w a pro-voa row ad requred repaeme
w a deve porea reorao. Ade-
quae ompoe reorao were pree
o ee #2(17) roug #5(14), ad #9(21),
#12(24), #15(27), #18(37) roug #23(32),
ad #26(42) roug #31(47). tee #1(18),
#16(28), #17(38), ad #32(48) were mg.
Figure 2. Preoperave appearae o e pae
me reveaed aeror ag ad uee
a araerzao.
Figure 1. Preoperave appearae demorae
e preee o ggva deay ad or a
row eg.
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Mor ggva ue orreo woud ao
be requred o mprove e a.3
Trtt pl
Aer mupe reame opo were d-
ued w e pae, dre veeer were
eeed o reore ee #5 roug #12 o
aer e me e ad e ade. too #13wa ao edued or row repaeme.
te oowg ep woud be oowed e
reame pa:
1) Continued periodontal maintenance and
good home care was expected, as it was
already habit or this patient.
2) Teeth #5 through #12 would be prepared
or veneers or veneer onlays.
3) A hybrid composite would be placed as
a base or the dentin shade and strength
in the fnal result.
4) Because the dentin structures were more
opaque and contained a more saturated
chroma, the use o a layered restorative
technique with calibrated translucencies
was selected to promote exceptionalesthetics and an accurate shade match.
5) An enamel-shaded microfll would be
placed over the dentin layer to be pol-
ished to a natural luster.
6) Maintenance o unctional occlusion would
ensure that the new composite veneers
would last in the new length and shape.
Figure 3. Foowg orodo reame, mproved
aera ad proruve gudae proeed aga
oua ereree.
Figure 4. te poo o e up p o e pre-
moar wa oger a e ae poo durg
preoperave evauao.
When patients present with dark underlying structures, aspecialty dentin shade (eg, B1 Dentin, 4 Seasons, IvoclarVivadent, Amherst, NY) should be placed on the cervicalaspect and tapered towards the incisal edge to create thedesired body shade, while adding strength to the underly-ing incisal length. Enamel Eects shades (White and Blue)can then be used to develop internal characterizations.
John Roberts, DDS
CLiniCaL Tip
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30/328 Anterior esthetic restorAtion Using A Direct resin Veneer techniqUe
EsthEtic ExcEllEncE
Figure 6. Pooperave vew. noe e mproved
a row eg, oo ape, ad oour.
Figure 5. Maary oua vew o u, rouded,
we-deed a edge.
Rtrtv squc
Duo regardg oo eg ad e
remova o e brow po were o prmary
mporae beaue ee were, eeay,
e pae prmary oer. Ea oo
wa prepared ad rebu dvduay o a
oo orm ad poo woud o be o
(Fgure 6). te oo preparao deg wa
maaed a mpe maer, w marg
maaed upraggvay, ad e a
rd o ea oo prepared more aggre-
vey o aow pae or e deveopme
o a ade ad rauey. care wa
ake o eed e preparao o e
erproma area ar eoug o emaeerproma adowg.4
Foowg rubber dam oao, a ear pa-
rp wa paed bewee ea prepara-
o o maa opma erproma o-
a. Ug e oa-e eque, e
ee were eed w a 35% popor
ad maera or 15 eod ad red or-
ougy. A mrobru wa ued o aborb e
ee waer o e bodg urae, ad
a adeve maera (e, EtE, ivoar Vva-
de, Amer, nY) wa geerouy agaed
o e preparao or 20 eod, e ar
dred o evaporae ay aoo arrer e
bodg age.5 t ayer wa g ured or
20 eod per oo.
sade B1 De (e, 4 seao, ivoar
Vvade, Amer, nY) wa paed o e
erva ape ad apered oward e
a edge o eab e body oor ad
o provde reg o e addo a
eg.6 t ao eped emae a rao
oor bewee e de body o e pre-
pared oo ad e dered eg. t ayerbeame e uoa urae o e gua
ape. Deveopmea obe were ube-
quey ormed ayer ad e aed.
iera araerzao were e added o
gve warm ad ep dereae e aura
edey o ee o beome oo gray we
reaed brge. trauey wa
ed aog e a edge o eourage
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Figure 8. Pooperave vew ow reaed
a row eg ad eaed ee.
Figure 7. ia gudae ad eurve move-
me were ao mproved pooperavey.
reogo o e uderg araer
oor. te ao ee wa ormed by beve-
g bak e a edge a e proper age
o reae a reraed e o g. severa ay-
er o e a re ayer were removed ad
repaed a aemp o reae proper oo
oour (Fgure 7). cae gudae wa e
deveoped o e gua ape.7 te Be-
e wa dued w md preure o
e baag de o e madbe o eure
a baag ad workg ereree were
eared.8 Proruve ouo wa vered
pror o deve g ad pog.
ierproma re wa removed w
g rp ad e-fued arbde buruder opou waer rrgao. Aoug e
aa urae were poed ug dk w
varyg gr, are wa ake o o remove a
urae eure reaed durg paeme o
e eame ayer o ompoe re.9
Cclu
Oe, e rebudg o a ere aeror oo
ompoe eeary e ed o de-
ry or mproved ommuao w eeram. te a aby o roug ou
e dered a reu or a porea veeer
ae ompoe pror o preparao a va
k or ay praoer a epe o ee
ee. Uderadg e opa propere
o ompoe re ao beome madaory
we e a makg dark, udery-
g oo ruure or aempg o reae
uormy oor o e preparao or a
porea veeer ae.
Rrc
1. Okeo JP. Maageme o temporomadbuar D-
order ad Ouo. Four Edo. s. lou, MO:
Moby; 1998.
2. Dawo PE. Evauao, Dago, ad treame o
Oua Probem. seod Edo. s. lou, MO:
Moby; 1989.
3. ce GJ, Pau A. Ee o Aeror Fed Proo-
do. caro sream, il: Queee Pubg; 1994.
4. Beage JR. surga reoruo o e erde-
a papa: cae repor. i J Perodo Re De
1992;12(2):145-151.
5. heyma hO, Baye sc. curre oep de
bodg: Foug o dea adeo aor. J Am
De Ao 1993;124(5):26-36.
6. Aber hF. too coored Reorave. 7 ed. ham-
o, Oaro: Bc Deker, i, Ao Book Dvo;
1985.
7. Ma A, ca c, Mrae R. ifuee o group u-
o ad ae gudae o eeromyograp av-
y o eevaor mue. J Proe De 1987;57(4):
494-500.8. Ruea cR. Fudamea o Ee. caro
sream, il: Queee Pubg; 1990.
9. Mer MB, caeao iR. Reay. houo, tx: Reay
Pubg; 2001.
* Private practice, Idaho Falls, Idaho. Accredited member
o the AACD.
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EsthEtic ExcEllEncE