Australasian Dentist Issue 92

CATEGORY AUSTRALASIAN DENTIST 89 LINICAL CASE 1 The patient presented to the practice with a failed endodontically treated tooth (Fig. 1). The patient-approved treatment planwas to place an implant (NobelActive 4.3 RP, Nobel Biocare, www.nobelbiocare.com ) at tooth site #8. After implant placement, the dentist flowed a temporary material (LuxaTemp. DMG America, www.dmgamerica.com ) around an impression coping to capture the exact shape, position and contours created by the custom temporary restoration (Fig. 2). Using eLAB Prime photographic protocols, the dentist took a polarised image of the temporary on tooth #8 and natural tooth #9 for communication with the laboratory (Fig. 3). At the laboratory, the image was imported into the eLAB prime software for shade analysis of natural tooth #9 and proposed ceramic formula for restoring tooth #8. The software proposed a milled low-translucency zirconia coping in shade A2 (IPS e.max ZirCAD) and specific layering ceramics (IPS e.max Ceram) to replicate the shade of natural tooth #9 (Fig. 4). Following the recommended recipe, the IPS e.max ZirCAD LT-A2 coping was milled and layered using IPS e.max Ceram. The completed crown was photographed following the eLAB protocol (Fig. 5) and virtually tried in the mouth to assess the degree to which the final crown matched the natural tooth, as well as to decide how to optimise the result before delivery to surgery (Fig. 6). The restoration on a mirror demonstrates the extensive layering required to match the natural dentition as prescribed in the digital recipe (Fig. 7). The final restoration was seated and photographed with the patient smiling (Fig. 8) and a retracted view (Fig. 9). CASE 2 A young woman presented to the practice with a large fracture on the mesial incisal of tooth #9 (Fig. 10) as a result of a fall. Because of her age and to ensure a harmonious, natural-looking rehabilitation, the dentist proposed restoring her smile with minimally prepped veneers placed on teeth #8 and #9. The dentist took a polarized RAW image of tooth #8 and #9 following eLAB_ prime protocols (Fig. 11), and sent the image to the laboratory. At the laboratory, the image was imported into the software for shade analysis. The software proposed feldspathic veneers layered with IPS e.max Ceram (Figs. 12-13). Figures 14 and 15 show a retracted view of the final veneers and a full-face smile. CONCLUSION From an aesthetic standpoint, restoring a single maxillary central is the most difficult challenge dentists and technicians face. A successful case outcome depends on a wide variety of critical factors both in the practice and in the laboratory. Use of the most sophisticated tools, techniques and materials to produce a restoration that blends harmoniously in the mouth relies on the ability of the dental team to communicate clearly and apply their combined clinical and technical skills to achieve an outcome that meets the patient’s expectations. The authors would like to give thanks to Amanda Seay, DDS, FAACD (Clinical Dentistry) and Sascha Hein, MDT (developer of the eLAB system). u Originally published by the Florida Dental Laboratory Association, Focus magazine, 1st Quarter 2022 Figure 7: Final restoration on a mirror. Figure 8: Final restoration seated and patient smiling. Figure 9: Retracted view of the seated restoration. Figure 10: Retracted view of the fractured tooth of a young female. Figure 11: Polarized photo of tooth #8 and fractured tooth #9. Figure 12: The polarized image imported into eLAB prime software proposes pressed IPS e.max veneers with layered ceramics. Figure 13: Final pressed veneers on a mirror. Note the heavy thickness of ceramic material to restore the missing mesial of tooth #9, which is missing, making shade matching extremely challenging. Figure 14: Retracted view of the seated restorations. Figure 15: Final restorations with patient smiling.