Evaluation of her TMJs was done and loading was comfortable.7 However, she had tension headaches originating from the temporal area, and she felt that she had more than one bite. Based on this information, it was decided to establish a stable occlusion first through the use of an occlusal/muscle deprogrammer. It was anticipated that the occlusion could be stabilized and treatment would be conservative in its approach, utilizing direct resin bonding in some fashion. Models were taken for the deprogrammer, sent to the dental laboratory, and then delivered a few weeks later. Once her occlusion was comfortable, diagnostic models from new impressions were fabricated. The plaster models were then mounted, using a bite registration that was taken with the deprogrammer in place, on a Panadent articulator (Panadent). Then a diagnostic equilibration was done. A diagnostic wax-up, which would simulate a level incisal plane, was created by our dental laboratory team (Figure 8). A putty matrix (Sil-Tech [Ivoclar Vivadent]) was molded over the wax mockup on the plaster model.
When the patient returned to the office at her next visit, a temporary BIS-GMA resin (Protemp Plus [3M ESPE]) was injected into the prefabricated putty matrix and placed into her mouth for 3 minutes. Removal of the putty matrix left the temporary resin in place over the teeth. This allowed the patient and me to view and evaluate the shape of the proposed treatment that would align her anterior teeth. The patient was very pleased, and we decided to proceed with the definitive treatment. Options of treatment included: porcelain veneers with tooth preparation; prepless veneers; and conservative direct resin bonding, which would lengthen the teeth only, leaving the rest of her anterior teeth untouched. It was anticipated that a no-preparation technique (except to lightly sand the facial surfaces with a coarse Sof-Lex [3M ESPE] disc, to aid in retention) would be used.
