Australasian Dentist Issue 92

CATEGORY 84 AUSTRALASIAN DENTIST LINICAL Solutions featured 3Shape TRIOS intraoral scanner 3Shape Smile Design 3Shape Dental System Case information The patient is a 39-year-old male with no remarkable medical history or condition. The patient looked to achieve his specific aesthetic goals with the restorations, in terms of shape and shade of the teeth. He had previously had composite restorations on his teeth that he was not satisfied with. He wanted a better and longer lasting outcome. Treatment plan The treatment plan was to firstly carry out a comprehensive analysis of his smile and to show the patient what the expected outcome would be. We would then carry out some bleaching of his teeth, followed by six upper ceramic veneers and four lower ceramic veneers. Initial consultation At the initial consultation, photos and pre-operative intraoral scans with 3Shape TRIOS were taken. After a brief discussion with the patient, the photos were imported into the 3Shape Smile Design module and a smile design was carried out. Figure 1 – 3. Teeth were selected from the smile library and modified to suit the desired outcome. The photo-realistic rendering was used to show the patient what the final result would look like. This included a simulation of the lower teeth as well, which was invaluable as the patient was also wanting to the address theminor shape and rotation issues with his lower incisors. Once the patient approved the smile design, this was transferred into 3D using CAD software and a 3D printed model for the patient’s final approval. Figure 4 -7. The patient then had bleach trays fabricated and began to bleach his teeth using carbamide peroxide gel for 2 weeks. The teeth were then left for a further two weeks to settle and to ensure that the resin- enamel bond strengths would return to normal. Tooth preparations were carried out on the upper six anterior teeth and four lower incisors and intraoral scanned. Good retraction and a dry working field is essential for an accurate intraoral scan. Figure 8-10. Provisional restorations were made using the 3D-printed model and a putty key. The provisional restorations were finalised and adjusted clinically, and then scanned again and sent to the lab to act as the final tooth position guide for the definitive restorations. The lab technician, Mr. Sho Kurashige, designed the ceramic veneers in 3Shape Design System, and lithium disilicate veneers milled and finally finished by hand on 3d printed master models. Figure 11-14. The lithiumdisilicate veneers were then tried in and bonded using a resin cement. The accuracy of the 3Shape intra-oral scanner and the precision of the technical workensuredaperfect fit of the restorations. The result was near-identical to the initial smile design, so what was initially planned was able to be delivered to the patient with no surprises or compromises. Figure 15-17 Summary The Smile Design module was able to help the patient and dentist get an accurate representation of the final aesthetic outcome of the planned anterior veneers. This was beneficial with ensuring the dentist understood what the patient’s aesthetic goals were, and to demonstrate to the patient what could be achieved. Using the digital workflow, the entire process was streamlined and efficient, and the patient’s expectations were able to be met. Six upper and four lower ceramic veneers restoration using smile design and digital workflow By Dr Chee Chang, Prosthodontic Centre, Glen Iris, Victoria, Australia Figure 1 – original oral situation Figure 3 – smile simulation with 3Shape Smile Design Figure 5 – Pre-existing tooth library forms customised to suit the clinical situation Figure 2 – original smile Figure 4 Figure 6 – Photo-realistic rendering of the lower incisors to show the patient what could be achieved Dr Chee Chang