In the hands of a talented laboratory and ceramists who understand how to adapt materials to obtain stunning results, such as the team at Corr Dental Designs, Ivoclar’s Empress pressed ceramics leads the way to showcase the exquisite beauty that can be obtained with restorative materials.
I was recently presented with a case where a patient wanted to re-do her old ceramic crowns on teeth #7, 8, 9, and 10. She did not like her short, square four front crowns and she was concerned about her “gummy smile.” She wanted a fabulous, bright, but natural smile. Her daughter was getting married in six weeks and she felt her smile could be improved with new restorations.
Upon examination and further discussion, we agreed the best outcome would require restoring ten teeth (#4 through #13). Her “gummy smile” could be corrected with laser gingival contouring (Figure 1 and 2).
I did the prerequisite impressions for study models, face-bow/horizontal stick bite, and appropriate photographs following the AACD standards. These were immediately sent to Corr Dental Designs with instruction for smile design wax-up on ten teeth, preparation guides, and a temporary putty matrix. Instructions were given regarding incisal edge position, buccal fullness required, and gingival contouring needs. I requested a short turn around time due to the forthcoming wedding. I also wanted to have enough time to allow for mishaps as well as complete tissue healing from the laser gingival contouring. Without hesitation, Corr Dental Designs obliged so I could proceed with her next appointment.
One week later the teeth were prepped according to the principles taught in The PAC hands-on programs. The gingival tissue was laser sculpted to minimize the “gummy smile,” and to allow the creation of a 78% width to length ratio of the anterior teeth (#8 and #9).
Because teeth #6 to #11 would require 360-degree preparations, the prep design allowed room for a smooth envelope of function as well as protrusive and lateral movements. This had not been the case with her old restorations, which caused wear and mobility of her lower anterior teeth.
Impressions were made, bites were taken, and photos of the preparation shade were done. Provisional restorations were made and all were sent to Corr Dental Designs with the request to expedite the case.
Three days later the patient returned to check the occlusion, function, phonetics, and aesthetics of the provisionals, as well as to select the final shade and characteristics desired.
The temporaries required aesthetic recontouring and shape improvements. I cannot overstate the need, in each case, to perfect and tweak the temporaries to provide the laboratory with a precise prototype of the desired outcome. A new impression of the final provisionals was taken and sent to the laboratory, along with final temporary photographs (Figures 3, 4, and 5).
I consulted with Gary Vaughn at Corr Dental Designs/The Pacific Aesthetic Studio and requested he
The exquisite restorations were delivered and bonded following the cementation protocol taught at The PAC hands-on programs. All restorations were placed and bonded at the same time.
The results speak for themselves (Figures 6, 7, and 8). Empress done by skilled ceramist, Gary Vaughn and the team at Corr Dental Designs gave this patient the ultimate aesthetic smile she wanted and deserved.
If you have questions about my article or if you would like to send a case, please contact the Pacific Aesthetic Laboratory Group at www.pacificaestheticdentalstudio.com, Gary Vaughn, CDT, CTO (916) 786-6740, or via email gvaughn@thePAC.org.