Treatment
After evaluating all diagnostic materials, it was clear that endodontic therapy was needed on tooth No. 10, and also possibly on tooth No. 9 (Figure 4). Root canal therapy (Smart Endodontics rotary system [Discus Dental]) was completed on No. 10 (Figure 5) and several weeks later, when it was deemed necessary, on No. 9. The defective veneers were removed with a high-speed air-driven handpiece (GentleSilence Lux 6500B [KaVo America]) and an 856-01C coarse diamond (SS White). Preparation depths for new veneers were established with depth cutting burs, Nos. LVS1 and LVS2 (Brasseler USA), and the axial preparations done with 2-grit chamfer burs Nos. LVS3 and LVS4 (Brasseler USA). The retraction cord was easily placed (Ultrapak 000 retraction cord [Ultradent Products]) with a specially designed cord packing instrument with a serrated end (Fischer’s Ultrapak Packer 45° Small [Ultradent Products]) (Figure 6). After 3 minutes, the cords were removed and Impregum Penta Soft Quick Step Light Body (3M ESPE) injected. A prepared stock tray (COE Plastic Disposable Tray [GC America]), previously coated with adhesive and dried, was filled with Impregum Penta Soft Quick Step Polyether Medium Body (3M ESPE) mixed in a Pentamix 2 Automatic Mixing Unit (3M ESPE). The filled tray was then seated and held in place to set according to the manufacturer’s instructions.
After the impression was removed, a very thin layer of Vaseline was painted on the composite on tooth No. 9 so that the temporary veneers would not bond to that composite. Temporary veneers were created by injecting Luxatemp Fluorescence (DMG America) into a Position Penta Quick (3M ESPE) impression of the aesthetic wax-up which Gina had approved. The provisional material was allowed to cure on the teeth. After setting, the flash was removed gently from the gingiva. Final trimming of the margins of the temporary veneers was done under magnification (Dimension-3 Dental Loupes [Kerr Orascoptic]) with a very fine finishing diamond (392-016VF Mosquito [SS White]). A thin coat of a liquid polish resin (Lasting Touch Nano-Technology Liquid Polish [DENTSPLY Caulk]) was brushed on following the manufacturer’s instructions and light-cured to give the temporary veneers a high luster (Figure 7).
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Figure 3. Deficient margins and remaining residual cement was obvious clinically. |
Figure 4. Periapical pathology on tooth No. 10. |
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Figure 5. Endodontic therapy using Smart Endodontics completed. |
Figure 6. Preparations completed with No. 000 cord (Ultrapak [Ultradent Products]) in place. |
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Figure 7. Temporaries were delivered. Note the high luster provided by applying a clear light-cured resin (Lasting Touch Nano-Technology Liquid Polish [DENTSPLY Caulk]). |
Figure 8. Postoperative smile. |
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Figure 9. Preoperative full face. |
Figure 10. Postoperative full face. |