New Case, Old Patient
A veneer remake with a paintable color-and-form concept
Step Bay
Let's get real, straight to the point: What do you do when you are asked to do a remake from 7 years ago? Look at this beautiful smile and the glow in the patient's eyes when she initially received her restorations (Figure 1). Her incisal edges followed her smile line. Everything looked beautiful.
Life went on, however, and 7 years later, the patient cracked the veneers on teeth Nos. 8 and 9. Now was the dental technician's time to restore her smile, again.
As dental technicians, we hate remakes. Perhaps the only thing worse is a remake of a remake. In order to avoid that scenario, the author wanted to get it close to perfect this time, so he chose to utilize the morphopsychology protocol to finish the case. Pressable lithium disilicate and a paintable color-and-form ceramic concept were selected as the ideal materials for this protocol.
Morphopsychology has been defined as establishing the links between physical or morphologic appearance and characterological or psychologic particulars.1 The author's morphopsychology protocol entails a concept of five modules, combined to finish a case, with very low odds of a remake: treatment plan, communication skill, elective dentistry, binary systems, and delivery follow-up.
Treatment Plan
The first question that needed to be asked when this case arrived in the laboratory was: Why is this remake necessary? The patient's other veneers remained intact, but Nos. 8 and 9 fractured. A close look at the model, however, revealed visible chips on Nos. 6, 10, and 11 (Figure 2). That indicated that the patient likely was not wearing a night guard consistently and all of the veneers were starting to give way.
In light of this information, the author believed that simply remaking teeth Nos. 8 and 9 to their original length would likely lead to another failure.
Communication Skill and Elective Dentistry
The decision was made that the patient would be best served receiving shorter veneers for teeth Nos. 8 and 9.
The question was whether the patient would be satisfied with the esthetics of this new smile.
The dental laboratory would need to relay this information to the dentist along with the new treatment plan. Surprising either the patient or the dentist is in no one's best interest.
The laboratory can decline to work on a case at any time. Matching a veneer to an older veneer is not easy. At least, in this case, it was two front teeth and not a single central. However, the question of payment must be addressed with a remake. The author provides a 5-year warranty on restorations, but this case was well past that.
After confirming that the treatment plan was acceptable and payment would not be a problem, the author was ready to start the case.
Binary System
A binary system consists of "yes" or "no." There is no cutting corners. The only acceptable outcome was to make it right.
The models were prepared, and an ideal core was waxed up with a base coping made of acrylic resin (PATTERN RESIN™ LS, GC America Inc.) (Figure 3). The technician invested and pressed with a high-strength lithium disilicate (GC Initial® LiSi Press MT-A1, GC America Inc.). After the tip was divested, the hot zone was drawn, and all the access areas on the model were trimmed to speed up sandblasting (Figure 4 and Figure 5).
After grinding and preparation of the core with a smooth polished surface for bubble-free ceramics, the initial buildup could be applied with ceramic (GC Initial® IQ ONE SQIN Body-A, GC America Inc.) (Figure 6).
After the bake, the author built up the Body-A ceramic along with Enamel-58 to an ideal full contour. The exaggerated protrusive and lateral movement was checked to determine the length of the incisal edge (Figure 7). The incisal edge was at its maximum length during lateral movement. It was also evident that tooth No. 10 was now longer than No. 9. The author made a note to advise the dentist to shorten No. 10 and possibly No. 7—not only for esthetic reasons, but also to keep them from future fractures (Figure 8).
Now that a set length for the incisal edge had been established, work could be started on the shape and contour, with contour being added for a second bake (Figure 9).
A mechanical lead pencil is the author's must-have tool for checking and shaping contour and texture on restorations (Figure 10). After that had been accomplished, a medium polishing wheel was used to bring the surface to a sheen finish, and the restoration was steam cleaned to prepare it for staining.
To this point, only two powders had been used: one for body and one for enamel. It was simple. Only one stain (GC Initial® Spectrum Stain SPS-2, GC America Inc.) would be used to apply the incisal effects. Just one stain can bring a veneer to life (Figure 11 and Figure 12).
After the stain bake, the margin needed to be added, and the author thought he was finished when taking that photograph. Photography is a great way to quality control your own work. Here, the author could see the distal gingiva of No. 9 needed to be thinned out to better match No. 8 (Figure 13 and Figure 14). After doing that, the author checked the contacts and the ceramic edge inside of the veneer and shipped it to the dentist.
Delivery Follow-up
The delivery follow-up is the only module of the author's morphopsychology protocol that should be considered optional. The author usually offers to travel to local clients' offices for delivery appointments to potentially stain the restorations chairside. The dentist in this case was out of state, however, so this was not a realistic possibility.
Nevertheless, the dentist communicated that they and the patient were both satisfied with the esthetics and the new veneers fit well. The author was confident that, based on the careful utilization of the morphopsychology protocol and the optimal material selection, the case would be a long-term success.
About the Author
Step Bay
Founder, CEO
ToothLab.Ai
Founder, CEO
Tooth Lab Solutions
Reference
1. Rufenacht CR. Fundamentals of Esthetics. Quintessence Publishing Company; 1990.
