Dental technicians very often like to define themselves as “artists”. It is true that they create, but their creations arise out of absolutely having to respect several rigorous parameters. Nevertheless, each individual dental technician can breathe life into their own style of working by drawing inspiration from their personal way of perceiving the reality that surrounds them, therefore discovering the pleasure of making excellent prostheses that satisfy the patient.

Description of a clinical case – The needs of both patients and dental personnel encourage the use of materials and techniques whose esthetic results are coming ever closer to perfection. The objective is to make a fixed prosthesis in zirconium oxide/ceramic for the price of a metal ceramic.

The clinical case presented in this article involved the manufacture of a prosthetic restoration with a framework made of zirconium oxide (Y-TZP) Cercon Smart Ceramics-Dentsply covered in pressed Press & Smile-Dentsply ceramic. The esthetics obtained using metal-free prostheses are better than those obtained using a traditional metal ceramic. The compromise of coating using the pressed ceramic technique also results in a restoration costing the same as a traditional prosthesis.

The role of communication has now become very important and awareness of this role has been growing during recent years.

When one speaks of communication, one immediately thinks of editorial communication, of the media, marketing, and the Internet. In reality, individuals communicate in every moment and in all sectors of their lives by exchanging knowledge and information.

The way in which we communicate is also the way in which we relate to others. The key to success lies in communicating in a simple and constructive manner, but above all by communicating with an interlocutor who is willing to listen. The best results are achieved when the communicator’s creative inspiration is added to the listener’s talent and communication.

In the field of dentistry, communication between the dentist and the dental technician is fundamental to an excellent prosthetic restoration . In particular, when there is a reciprocal exchange of information between the dentist and the dental technician concerning their respective competences, the patient is certainly the first to benefit. Consequently, it is essential for the dentist to know how to follow laboratory procedures in order to manufacture a prosthetic restoration and even engage him or herself in the manufacturing process in order to improve their understanding of the problems arising during the process and to solve them by working together with the dental technician.

As luck would have it, twenty years ago, when I arrived in the United States, I went to work at the dental clinic, Goldstein, Goldstein, and Garber considered by many one of the best dental clinics across North America. At that time GGG was considered the pioneer clinic of cosmetic dentistry.

Before arriving to Atlanta from Italy, I had used the platinum foil technique to fabricate jacket crowns, as it was customary in Europe. At that time, laminate veneers were virtually unknown to me, although it was very popular at Goldstein, Goldstein and Garber.

The esthetic and functional restoration of the stomatological apparatus is the ultimate objective of any prosthetic rehabilitation. The success of the dental treatment can only be obtained when the team, composed of the patient, prosthetist, and dental technician, are in full and harmonious agreement in planning and carrying out the various phases.

Positioning implants must not, in fact, be thought of as a surgical goal in itself because it is a necessary pre-condition for achieving the aim of anatomic and functional integrity of the stomatognathic apparatus (function).

For the prosthetic outcome to be a success, every phase in the prosthetic rehabilitation must be guaranteed (technical and clinical protocol), that is: a prosthetically guided positioning of the implant, correct choices made for the abutment, for the prosthetic superstructure, and for the esthetic coating materials, as well as an appropriate occlusal scheme having characteristics that guarantee good masticatory wear resistance.

We were lead to treat a 57 year-old female patient in order to find a solution to her mandibular clinical situation. Following the extraction of teeth 35 and 47, her present stellite no longer offers the function and stability required and moreover, the aesthetic aspect needed to be improved. The remaining teeth did not show any mobility and the patient’s overall health was good. A fixed restoration would have been possible, however, the patient did not want to undergo a tedious surgical treatment to install implants. Consequently, she chose a removable restoration with attachments, which was more suited to her wishes.

Introduction

Among the challenging tasks facing dental ceramists is to accurately and predictably achieving a shade match to a single central incisor while spending as little time as possible at the bench. Unfortunately, techniques and materials that enable a guaranteed “what you see is what you get” result have been elusive—until recently. The introduction of a material called lithium disilicate (IPS e.max Press, Ivoclar Vivadent, Amherst, NY) allows ceramists to fabricate with enhanced productivity predictable esthetic restorations that demonstrate the combination of exceptional esthetics and high strength. The technique illustrated here represents a step-by-step process developed for use with the IPS e.max Press lithium disilicate material to accurately and predictably match a single central incisor in an efficient manner by mimicking the internal effects of a natural tooth. Further, the technique also involves creating a natural-looking optical effect by enameling over these characteristics to quickly and precisely return to full contour.

Although the technique is not illustrated on a real case, it does demonstrate the manner in which a complex central incisor (eg: tooth #9) can be recreated. Since the number of such detailed instructional articles in the literature is limited, readers should find this pictorial example beneficial.

Over the years, there have been many developments in restorative materials for aesthetic dentistry. While pressable ceramics and alumina porcelain, such as Procera have been clinically utilized for many number of years as alternatives to porcelain-fused-tometal, new materials like zirconia structures and porcelains are more widely available for use in the dental industry.

Through the continued evolution of these materials, as well as advancement of restorative techniques and laboratory fabrication procedures, dental professionals are provided with the necessary tools to treat patients requiring either replacement or enhancement of the natural teeth.

In order to maximize the potential of the vast array of options the technician must have an understanding of what the specifications of each material and technique are including possible limitations in order to achieve the best result for each particular application.

When restoring with laminate veneers there are also many different materials to choose from as well as available techniques. Depending on the purpose of the restoration from restoring color to the under layer or blocking out desired areas, it is in the hands of the dental restorative team to decide what is the best choice of options.

Introduction

Completion of parts one and two of this article left the patient ready for final restoration fabrication and seating.

The following have been accomplished for the patient:

1. A DATA Appliance has been utilized to create a Stable Biomechanical Platform.

2. Ideal functional and esthetic restorative treatment objectives have been determined and designed on this platform.

3. Tooth preparations and crown lengthening procedures consistent with this design have been performed.

4. Provisional restorations matching this design have been fabricated and seated.

This, the final part of this article, will illustrate a process for creating and seating final restorations mimicking the esthetic and functional qualities developed in these provisional restorations. Key functional and esthetic qualities requiring communication will be listed and methods of communicating them detailed. In conclusion, techniques for utilizing the DATA Appliance to perfect and protect these restorations will be described.

Introduction

Every technician knows that a single anterior tooth is the hardest to match when taking a patient’s custom shade. In the first case study below, a minimum veneer preparation revealed a very dark stump shade that would need to be masked with porcelain and translucency. Under this category come several other issues, such as: Will a platinum foil technique produce the best restoration? How will we control opacity? What about the adjacent teeth – what is their color? Is there any white calcification? Is the white color subtle, medium, or solid?

These questions, or something similar, seemed to come up over and over again when I reviewed the various cases sent into the lab for fabrication. And I came to realize that we didn’t really have a very good method of communicating shade with each other-the dentist, the patient and the technician- especially if there was anything unusual about the case.

The imitation and manufacture of incisors has always been a particularly hard task for dental technicians. When called to rehabilitate an individual incisor, the operator needs to cope with several problems, sometimes insuperable, especially when there are no chances to see the patient in the laboratory. In order to achieve acceptable results, a perfect layering technique, much expertise, familiarity with the tricks of the trade and a close cooperation with the clinician are fundamental. In the following article, the author presents 3 clinical cases.