New Dr's First Case

[rkm rdt]

This patient wanted both centrals veneered to improve the incisal edges.Her laterals had been veneered about 1 year ago.




The Dr didn't think the patient would be willing to restore all 4 veneers.



I presented the patient with a diagnostic wax-up of the 4 veneers and another with just the centrals veneered.
I then asked the pt which shade she would like me to select,the A2 veneers or the A1 centrals.
She agreed to have all 4 anteriors veneered to A1.

The direct temps were made from Crystal clear silicone matrix of the diagnostic wax-up.



I used an Emax Lt A1 ingot ,cut back and layered with OE 2 and I1 trans incisal.

The patient and Dr were happy with the results.

 

[araucaria]

just curious - are there any issues with the patient grinding ? looking at the lower incisors I'm wondering what effects there might be on the restorations.

 

[TheLabGuy]

just curious - are there any issues with the patient grinding ? looking at the lower incisors I'm wondering what effects there might be on the restorations.

I agree Araucaria, rkm did you have the Doc take an impression for an orthotic appliance to protect that pretty work? She looks a ton better, much more feminine, you gave her back a decade. Great, another Canadian Cougar running around

 

[rkm rdt]

just curious - are there any issues with the patient grinding ? looking at the lower incisors I'm wondering what effects there might be on the restorations.

As with most real life situations,we tend to address the cosmetics before the structural concerns.

Having said that , the next step is to address and restore the lower incisals.

She has good cuspid guidance. Actually She is a nail biter , not a grinder,so I think we will be ok.

 

[rkm rdt]

I agree Araucaria, rkm did you have the Doc take an impression for an orthotic appliance to protect that pretty work? She looks a ton better, much more feminine, you gave her back a decade. Great, another Canadian Cougar running around

I recommend a simple bleaching tray as temporary appliance untill the lowers are addressed.

 

[TheLabGuy]

I recommend a simple bleaching tray as temporary appliance untill the lowers are addressed.

Yeah, but if that is parafunction, you can't cure that by doing the lowers brother. You can't stop bruxism, only protect yourself from what it does. I have some client/patients out there that go through a new bruxism appliance every 6 months. It's better to wear out an orthotic appliance than chipping, cracking, or wearing down your pretty work

 

[Bobby Orr ceramics]

I suspect the core problem here is this patient has a constricted airway problem that is causing the bruxism. Possibly some jaw joint issues also lookin at the pre-op wear pattern of teeth.

Nice work RKM...... however, the game here is protection. not more treatment on lowers as Rob stated.

appliance holding mandible thru the night is key.

 

[Gdentallab]

nice work,
i;m sure you caught him for many cases to come.

 

[rkm rdt]

She's a nail biter.
Any bruxism would remove the cuspid rise which is not the case here however I do recommend an appliance for all veneer cases I do.

We will be making an applliance once the lowers are restored.Don't worry guys, I charge enough to make them want to keep them!

 

[rkm rdt]

nice work,
i;m sure you caught him for many cases to come.

Thanks G,

 

[TheLabGuy]

Don't worry guys, I charge enough to make them want to keep them!

Yeah, I seen now you put "nail biter", enough said. I love what you wrote above...

 

[CYNOSURER]

You can't stop bruxism, only protect yourself from what it does. I have some client/patients out there that go through a new bruxism appliance every 6 months.

Have you tried a Valplast nightguard on those heavy bruxers?

 

[TheLabGuy]

Have you tried a Valplast nightguard on those heavy bruxers?

Never really thought of that to be honest. How does it wear? I imagine it wasn't initially designed for that, but is Valplast selling it for that purpose?...a clear Valplast? That stuff is so strong and so thin, I could easily see the application.

 

[CYNOSURER]

Never really thought of that to be honest. How does it wear? I imagine it wasn't initially designed for that, but is Valplast selling it for that purpose?...a clear Valplast? That stuff is so strong and so thin, I could easily see the application.

It's not clear but a white opaque. You can see it here:

David Blaine's Magic Bullet Catch

Scroll down past the YouTube clip to see close up photos of the mouthguards. Click on them to enlarge.

 

[rkm rdt]

I like Talon.

 

[JonB]

... you could always do them out of full contour monolithic zirconia... if aesthetics weren't an issue!