At the AACD s scientific sessions in Atlanta and New Orleans, Zenith Dental

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1 Fac i a l Ch a n g e s Th r o u g h De n ta l Te m p o r i z at i o n by Elliot Mechanic, DDS Montreal, QC Canada info@drmechanic.com At the AACD s scientific sessions in Atlanta and New Orleans, Zenith Dental sponsored hands-on courses demonstrating artistic dental temporization and the ability to create facial changes through esthetic dentistry. The response to these programs was extremely positive; this article will review the concepts that were presented. Esthetic dentistry not only has the ability to alter a person s appearance, but can affect their personality as well. Esthetic dentistry not only has the ability to alter a person s appearance, but can affect their personality as well. By modifying the length, form, and position of the teeth, we can reduce years from a person s appearance and/or give them facial traits that they desire. Usually a dental makeover will lead to other forms of beautification, often beginning with a new hairstyle. Although some patients proceed to have plastic surgeries, most do not care or need to go to such extremes. Esthetic dental changes, a new hairstyle, new ways of applying make-up, and a new wardrobe can result in a dramatic boost to one s self confidence. The Role of the Provisional Restoration The ability to create and modify provisional restorations simply and quickly has opened the door to predictable esthetic dental changes. As opposed to other plastic surgeries, dental temporization can give the patient a chance to preview his or her new smile, live with it for a while, show it to family and friends, and alter it as necessary. 166

2 Restorative Dentistry Figure 1: The first patient desired longer teeth and a fuller smile to counteract her round facial form. Figure 2: The second patient desired a wider smile with very white teeth. A putty template is created from a diagnostic wax-up or mock-up created directly on the patient s teeth; this is later filled with an injectable bis-acryl material and placed over the patient s prepared teeth. These provisionals can then be trimmed, modified, and glazed to give a lifelike realism. Participants in the hands-on course were provided with Luxatemp Fluorescence (Zenith/ DMG, Englewood, NJ). Its patented 10:1 base:catalyst ratio provides the right blend of strength, esthetics, accuracy, and fast set time. It can be easily added to and modified using Luxaflow (Zenith/DMG) or any microfill composite, and then glazed with Luxaglaze (Zenith/DMG), which not only gives it polish but also adds to its strength. Dental temporization can give the patient a chance to preview his or her new smile, live with it for a while, show it to family and friends, and alter it as necessary. A well-made provisional is the key to an esthetic restoration. It provides the laboratory technician with a blueprint for tooth length, width, thickness, arch form, midline cant, incisal edge position, and occlusal scheme. Once the patient has approved the form of the provisional, the technician replicates all the parameters in porcelain using silicone templates fabricated from a plaster model of the temporary. You cannot go wrong! Patients 1 a n d 2 Participants in the hands-on program were shown photographs of and told the background of two different patients desiring esthetic dentistry. (Figs 1 & 2) After assessing the dentition and desires of the pa- 167

3 Figure 3: Template for the first patient. Figure 4: Template and wax-up for the second patient. Figure 5: The first patient loved her new look. 168

4 Restorative Dentistry Figure 6: The second patient returned saying that she did not like her smile at all She dreamed of having a big, wide, toothy grin. Figure 7: The first patient, with slightly longer teeth with sharper corners. tients, diagnostic wax-ups were created using the information gathered to achieve their esthetic goals. The first patient desired longer teeth and a fuller smile to counteract her round facial form. She said that she felt tired and old. The second patient desired a wider smile with very white teeth. She had existing 10-year-old porcelain veneers that she felt were overcontoured and too dark. Each of the course participants was instructed to fabricate a Luxatemp provisional restoration using a putty template created from the wax-up. (Figs 3 & 4) The temporary restoration is the first and most dramatic factor in creating a major esthetic change. After the participants temporized the patients, they were shown photographs of the way the patients looked with their new provisionals. We then removed the photos from the screen as if the patients had left our offices and gone home. The patients were told to live with their new smiles for a few weeks and assess any changes they wanted to make. We then placed their photos back on the screen as if they were returning for their followup visit, and the course participants learned what each patient liked and did not like. (Figs 5 & 6) The first patient loved her new look; she felt sexy, alive and exciting. She had even changed her hairstyle. When asked if she wanted even sexier teeth, she responded with an emphatic Yes! We decided to not drastically change the look of the provisional, as the patient loved it, but to only sharpen the corners and lengthen it slightly to give the smile a more exciting edge. The second patient returned saying that she did not like her smile at all it just wasn t her. When 169

5 Figure 8: The wider smile that the second patient desired. questioned further, she stated that people always said that she reminded them of Julia Roberts. She dreamed of having a big, wide, toothy grin just like Julia s! Although to many of the participants the initial temporization looked beautiful, they were instructed to take the customer is always right approach and provide the patient with exactly what she wanted. They were instructed to modify the provisional by widening it as much as possible while still respecting the position of the underlying teeth. The participants then modified the temporaries with flowable and microfill composite resin, sandpaper disks, diamond finishing burs, and LuxaGlaze until the two patients were totally satisfied and signed consent forms that they accepted the shape of the proposed restoration (Figs 7 & 8). Using this technique, the patients were able to visualize exactly what they would be getting, therefore eliminating guesswork by both the dentist and laboratory technician. Every person has their own idea of how they want to look; beauty truly is in the eye of the beholder. Co n c l u s i o n Redo-a-dontics is very frustrating, time-consuming, and expensive for the dentist, the laboratory technician, and the patient. Sending a case to a dental laboratory without a definitive plan results in guesswork, leaving responsibility for the smile design to the dental technician. It is time-consuming, uncomfortable, and risky to anesthetize, remove dental temporaries, retemporize, and return a case to the laboratory for modifications. This often involves even more guesswork. Nobody wins! By taking extra time, even if it involves a few extra visits and by creating a provisional restoration satisfying the esthetic needs of the patient the dentist can communicate what is required to the lab technician, who can create a template from this blueprint to enable him or her to create a porcelain restoration and virtually eliminate the guesswork. This prototype restoration can accurately convey the tooth length, incisal edge position, labial and lingual contour, midline position, contour and position of the line angles, emergence profile, and incisal and gingival embrasure architecture. Detailed lab prescriptions no longer become necessary. A photo, plaster model, and instruction to the technician to copy the provisionals are all that are needed. The magic combination of meticulous treatment planning, communication, and special chemistry between patient, dental team, and laboratory technician usually exists in our most successful cases. By mastering creative dental temporization and working hand in hand with our lab technicians, dentists can get it right the first time. Editor s Note: This article was based on a corporate workshop by Zenith Dental, presented at the AACD s Excellence in Cosmetic Dentistry 2008, in New Orleans, Louisiana. v 170