Kristine Aadland Here is the second case presented at DS World. Another case where things didn't go quite as planned but it had some good tricks and tips.
This is a woman who is in her mid thirties, an engineer and has a twin sister. She had trauma to #9 and her smile no longer looks the same as her sister's smile and she wants it fixed. She also hates the grey band on #8. She has had several consults with different providers and would like both of her front teeth fixed. The important characteristics to her was that they were the same size and they looked "natural."
I struggled a little with this case prepping #8 because there was no prior work done and this was purely for esthetics. I brought up different possibilities of what we could do, but in the end the patient really wanted to teeth to match. For esthetic reasons, it is best have similar prep designs. I also chose to use an opaquer to block out the grey band in the tooth.
For this case I decided to use Biogeneric Individual. This is a case I did in one visit so I did not do a wax-up. When I design case like this, I love to use the Grid Mode to line up the midline and angles of the teeth. This can be placed easily by pushing "Control G".
The other tool I like to use to measure the widths of teeth when working on multiple anteriors is the distance tool. This can be found under Analyzing Tools. In this case both widths were 8.6.
When I first planned this case I decided ot use Vita Mark II because it is gorgeous and can mask a lot of color. After it was milled, I tried it in and it was a little bright but I was going try to tone it down with some staining and glazing. Right as I went to hand the veneer to my assistant...
Yep, I dropped it and when I took a breath in and moved slightly it was like it jumped right under the wheel of my chair and I heard that distinct sound of breaking glass. What a day! The other fun fact was I had no other Vita blocks so I needed to remill. I tend to think Vita Mark II is similar to e.max MT blocks so I chose to remill in an e.max B1 MT but unfortunately this was just way too bright. I use MT a lot in anteriors so I am not one to say they are always too bright. I think they are often really beautiful but if you really look at her original smile she has a lot of translucency and grey in her teeth- more like a c value. I should have picked this up but I didn't, so I milled this case for a third time in one day and settled on a B1 HT.
What can really make or break a case when working on front teeth is making sure you have similar facial contours. I check this by looking down the incisal edges and also by taking pictures to make sure my reflections are similar. I also decided to keep the cingulum on #8 for added strength.
This case didn't need a ton of staining- just some white to set the framework and some I2 for translucency. When I am staining anteriors I always follow a pattern and my assistants do the same.
1. I paint on the glaze first all over the tooth. This is thick in consistency but thin in thickness. I do not mix the liquid in this.
2. I do my body stain next and blend it in the gingival third, however in this particular case I did not feel she needed it.
3. I paint translucency at the incisal edge in a zigzag pattern with a light touch about 1mm down or so or following the pattern of neighboring teeth. In this case I painted the I2 about a 1/3 of the way down.
4. I frame the tooth with white or cream. In this case I used white and just at the incisal edge and mesial and distal marginal ridges
It was a long day but she got caught up on her Netflix episodes and was happy to wait for a result she wanted. She understood that I had other cases at the same time and was grateful we were willing to remill to make it right. She was happy when she left.
