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Not many options are open to patients in terms of dental care in the following case. Higher levels of occupational stress and extreme bruxism had already worn out two ceramic
In addition, three different implant systems had some time ago been inserted in
the upper and lower jaw. Hans Frieder Eisenmann and the dentist saw
only one way out - which also provided them with a challenge.
When discussing smile design, we don’t necessarily need to be talking about many
teeth involved in the process. Smile design is no more than finding the proper balance and
harmony for someone’s smile. The proper balance between the tooth size and form, and the relation to the gingival tissue, play a big role in what we call the smile design.
Imitating pink tissue color is essential for the best natural esthetics when it comes to cosmetic restorations. Often, this step is neglected because the technician fabricating the case does not realize his options. But, in the author’s opinion, the creativity that goes into this step cannot be underestimated. Our case study will explore not only the esthetics of this case, but also the importance of pink tissue design.
Master artists captivate the viewer by transforming their work using simple esthetics. An esthetic that captures the essential details, that envelops nature and grasps even its flaws, and esthetic that incorporates all of nature’s intensity without becoming artificial. Whether it’s a writer capturing an experience in words, a musician making feelings audible or the dental technician using ceramics to layer the complexity of a living tooth – all these have only one purpose and goal: to come across as real and true.
The authors of this article, Ernst A. Hegenbarth and Yasuhiro Tsujino masterfully articulate – using images, text and ceramics – their experience in implementing the artistic in harmony with nature.
Patients seek esthetic dental treatment for a number of reasons, from personal gratification to professional success. Although there is no universal recipe, some cases can effectively be restored using "prepless" veneers. They can correct esthetic and functional problems by fully preserving the tooth structures. They can be indicated as a pure cosmetic treatment in discoloration of the tooth structures, correcting altered tooth form, position and proportion, trauma, wear, spacing or for functional reasons in
establishing anterior and canine guidance.
Apart from a wide processing spectrum (metal framework, zirconia framework, lithium
disilicate framework), efficient layering concepts aimed at meeting high aesthetic demands
such as light transmission, reflection and absorption are expected.
Processability (degree of humidity, positional stability, firing settings, bond strength etc.) is also a criterion that has to be fulfilled in order to ensure a successful processing. The time required for a bond modification between the framework and the veneering ceramic as well as the shade stability shall also be taken into account.
This case involves custom shade matching for two lateral teeth. The most important aspect of this shade matching is to look at the opacity of the adjacent teeth in order to achieve an accurate color.
Most cases of this nature will indicate approximately 50% opacity. In order to relate it
properly to the other colors in the dentition, such as white, tan, yellow, orange, brown or grey, we must also identify the proper amount of translucency.
As high end technicians, we have been programmed to believe that only multi-layering will
allow us to achieve an accurate match with existing dentition. This is sometimes true, but not always.
This article will illustrate how to approach the same type of situation with less time involved, and still
keep our patients happy.
Most laboratories receive implant cases which have aesthetic difficulties that they have to solve: the parallelism, difficult types of implants, at the same time implant’s depth in the gum and implants position. What I have noticed most often is the bone loss in most cases; even after a bone graft, a few months later you would notice that this artificial bone has moved from its original position or has resorbed. This causes defective lip support, incorrect tooth position, disharmony in the smile and muscles of the face which will not act or move in the same manner.
Ensuring that anterior dentures are of a high quality and are aesthetically pleasing always requires specific planning, especially when they are used in combination with dental implants, and dental technicians must be highly experienced with a great deal of expertise. A quick and cost-effective solution to this problem is provided by ZENTOEC SCI.ENCE, an intelligent and innovative platform with a wide range of offerings for specific indications.
Software-assisted tailoring makes it possible to provide optimal levels of care even in borderline cases, as shown by the example described here by Martin Gadau.
A young gentleman 26 years of age was seeking replacement of his anterior tooth #8, having had an accident while playing hockey some time earlier. (In fact, on that day, he was the second patient the author saw who had had a hockey accident!) In the laboratory setting, custom shade matching procedures were carried out, with the author taking the following steps:
• He first checked the after-prep color. All dental professionals have generic and simply made shade tabs in order to double-check stump shades. However, they do not accurately describe any colors other than the
ones which are monochromatic in nature. Therefore, he used his own custom made shade tabs with lifelike stump shades including gingival and body color. These colors help predict the final case outcome.
• He next checked the translucency/ transparency amount with his own specific shade guide tool. He needed to know not only the amount of translucency or transparency to include but also the color – light opal, grey,
clear or tan. He would indicate the amount to include and then apply it to his final build-up procedure. The patient presented with heavy translucency. However, the tooth was still a bit protrusive since facial preparation was not heavy. The patient had sensitivity to the preparation, leaving the clinician unable to prepare the tooth as deeply as he would have liked.
• The second and third build-ups were layered onto the restoration in order to create the desired effect. After firing, the shape was recontoured and the texture was applied. Natural glazing vs. glazing was the next step and the type of glaze depended on the patient’s dentition. Following these steps helped the author to create a predictable restoration based on his custom shade matching procedures and might benefit the reader, as well.