Ross Enfinger Intro: Interdisciplinary dental care is a staple of both the Spear Education and CDOCS core philosophies and, with the ongoing advances in CEREC technology, delivering comprehensive treatment has never been easier. Now more than ever, patients expect efficient and predictable restorative solutions, and these expectations can be routinely delivered with some creativity. The following case is a demonstration of how out-of-the-box thinking can be combined with our CEREC technology to create an entirely new smile for our deserving patient.
Case study: The patient presented with severe anterior wear necessitating indirect restorations; however, the resulting segmental supra eruption of the maxillary and mandibular incisors had reduced the inter arch space, therefore there was not adequate restorative space. (Fig. 1: Pre-operative condition)
Figure 1
To better communicate the restorative challenges to the patient, the Spear Facially Generated Treatment Planning (FGTP) templates where superimposed over the patient's smile using Keynote (Macintosh) presentation software. (Fig. 2: FGTP templates)
Figure 2
When viewing the prospective smile design plan, it became obvious that segmental orthodontic intrusion of the upper and lower incisors would be necessary to gain the necessary restorative space to treat the anterior teeth. The patient was then referred to the orthodontist and the orthodontic intrusion plan was finalized. Orthodontic brackets were bonded, and wires were pre-bent to achieve the necessary intrusion as guided by the FGTP templates. After several months or active treatment and several additional months of stabilization, the orthodontic movements were complete. (Fig. 3: Orthodontic progression)
Figure 3
Before removing the brackets, though, the dentition was imaged with Primescan and the CEREC software was then used to design prepless anterior overlays to test drive the occlusion and phonetics. (Fig 4: Anterior overlay design)
Figure 4
Next, Tetric CAD (Ivoclar) overlay restorations were milled on the MCXL in shade A3 and were then bonded to the intruded maxillary and mandibular incisors. (Fig. 5: Anterior overlays)
Figure 5
Once the esthetics, function, and phonetics were approved by the patient, the orthodontic brackets and wire were finally removed, The Tetric CAD overlay provision restorations were then used as a Biocopy image for the design of the final restorations. (Fig. 6: Biocopy image)
Figure 6
Next, the bonded overlays were then used as a preparation guide for the adequate reduction prior to the final refined veneer preparations. (Fig. 7: Final preparations)
Figure 7
The initial restorative Biocopy proposal was then improved using the software’s design tools to create ideal anterior form. Final veneer restorations for teeth #7-10 and 23-26 were then milled from Ivoclar e.max MT A3.5 and were adhesively bonded to create the final smile makeover. (Fig. 8: Final post-op smile)
Figure 8
Summary: Using a combination of traditional orthodontic techniques and progressive digital technology, a difficult restorative case was made predicable and relatively straightforward thanks to use of Spear FGTP concepts to predict the outcome before the case was ever started, by beginning with the end point in mind, a clear pathway to the final smile design can be followed.
