The mandibular arch was completed with the proper occlusal plane and curve of Spee. After 8 weeks of healing time following crown lengthening surgery of teeth Nos. 5 and 12, preparation of the maxillary arch began the day after delivery of the mandibular arch. An axial reduction guide and incisal edge Sil-Tech Putty matrix of the original maxillary teeth directed the preparations in a similar manner as the mandibular preparations. The authors used the acid-etch technique to bond the restorations in place. The preparations are etched with Etch-Rite™ 38% phosphoric acid gel (Pulpdent, www.pulpdent.com) for 20 seconds, washed thoroughly, and dried, followed by placing several coats of Dentin Desensitizer (Pulpdent). Several coats of OptiBond™ FL (Kerr Corporation, www.kerrdental.com) primer were then applied, followed by one coat of adhesive. These coats were slightly air dispersed, then light cured for 20 seconds. The restorations were cleaned with Ivoclean (Ivoclar Vivadent) for 20 seconds, rinsed, and air-dried; then one drop of Silane Primer (Kerr Corporation) was placed and air dispersed. Final cementation was completed with Calibra® Esthetic Resin Cement (DENTSPLY Caulk, www.dentsply.com).
Proper finishing of restorations is essential for gingival health and long-term case success. Three burs were used to initiate the finishing process. First, a red-striped 30-grit diamond (Brasseler) was used around all margins, followed by a yellow-striped 15-grit diamond (Brasseler), and then a white-striped 30-bladed finishing bur (Brasseler). Next, Shofu polishing points were used, starting with the no-stripe point, then the yellow-striped, and lastly, the white-striped polishing point (Shofu, www.shofu.com). The interproximal finishing began next using a Cerisaw™ (DenMat, www.denmat.com) to first clear out excess cement in the interproximal areas, then a red-striped Gateway flex diamond strip (Brasseler) was utilized to smooth each interproximal surface. The last and most significant interproximal polishing was with the series of Epitex® finishing strips (GC America, www.gcamerica.com). After the blue, green, gray, and tan strips were used, flossing between the teeth was extremely smooth, and the polishing sequence was complete. A functional and esthetic improvement was achieved with the new restorations (Figure 8 through Figure 10).
This patient’s case presented a functional challenge that was not evident at first glance. Listening to this patient’s chief complaint and comparing pre- and post-treatment models identified the functional dilemma. The authors were able to address the lip closure issues and violation of envelope of function as well as improve gingival zenith and coloration. All involved in this case were pleased with the final results.
William P.D. Wynne, DDS, is the creator of the Wynne 2000, which is sold by Great Lakes Orthodontics.
Laboratory fabrication by John Wilson of Wilson Dental Arts.
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