Delivery of the Final Restorations
Teeth Nos. 22 to 27 received orthodontic care (during which tooth No. 23 was also extracted) to align with the anticipated position of the maxillary anterior teeth. Six veneers (including one for a lower premolar tooth) would be delivered for the anterior mandibular arch to restore it to ideal form, position, and aesthetics. These restorations would be seated with the combination of a self-etching, self-priming, light-cured adhesive system and resin cement (BiFix QM [VOCO]).
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| Figure 18. Occlusal view of the maxillary dentition following insertion of the definitive restorations. | Figure 19. Final view of the patient (4 weeks postoperatively). |
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| Figure 20. Retracted postoperative view. | Figure 21. Postoperative view of the anterior maxilla demonstrating the predictable results achievable when using the proper collaborative (interdisciplinary) techniques. |
Delivery of the definitive maxillary restorations was conducted at a second appointment in order to provide sufficient time for the healing of the gingival tissues and extraction sockets. The single-unit PFM crowns and bridge were accomplished with self-etching resin cement. Final occlusal adjustments were performed, and then the restorations were polished to a natural luster (Figure 18).
The patient was recalled approximately 3 weeks postoperatively for follow-up, including taking the final case photos (Figures 19 to 21) and to confirm success of the treatment.
DISCUSSION
The precision of the resulting indirect restorations was directly influenced by the accuracy (defined as the ability to properly relate all the details of the prepared teeth) of the impressions taken in this case. Consequently, it was imperative that I obtain an impression that duplicated the prepared teeth as well as the uncut tooth surfaces beyond the margins. The 2 combined would enable the dental laboratory technicians to ascertain the exact position and configuration of the finish line. The adjacent teeth and gingival tissues were also encompassed and reproduced in the void-free impression, which consequently allowed the casts to be properly articulated and the restorations to be naturally contoured.
CONCLUSION
Multiple factors contribute to the success of any case, including the one presented in the following description:
One was the digital simulation from Smile-Vision, which aided considerably in gaining patient acceptance of the treatment plan. It also allowed for efficient treatment planning (as well as yielding the resin replica, preparation guide, and template for the provisional restorations).
The impression material chosen, with its extended working time and accompanying surfactant, made it conducive to multiple treatment sites, enabling me to proceed with confidence through this otherwise technique-sensitive process. Ultimately, we are only as good as our impressions, no matter how many hours are spent preparing the dentition.
Finally, the collaborative approach—involving our periodontist, orthodontist, endodontist, and dental laboratory technicians—allowed each professional to optimize the health, position, and function of the dentition prior to restorative care. All involved provided valuable contributions to the outcome depicted herein.