Axsys Dental Solutions -Case Study

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Clinical Case Studies

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Correcting a Tooth Size Discrepancy

Using a Digital Workflow

Case Example by Friedman Dentistry

Case Facts

Doctor: Dr. Mark Friedman, DDS
Problem: Tooth size discrepancy of the maxillary anterior teeth.
                       Lack of canine guidance. Direct composite bonding
                       on teeth #’s 6-11 with chipping and deterioration of the
                       restorations.
Tooth Number(s): 6-11
Material: GC Cerasmart CAD blocks, Gradia CT

History

A 20-year old male patient, with a healthy definition and Class I occlusion presents with a tooth size discrepancy of the maxillary anterior teeth. He lacks canine guidance and has direct composite bonding on teeth numbers 6-11 with chipping and deterioration of the restorations.

Treatment Plan

To provide the most conservative esthetic restorative option, indirect composite veneers were planned without preparing the natural teeth.

Treatment Sequence

The initial planning phase of treatment involved removal of the existing composite and polishing of the natural underlying enamel. A pretreatment digital scan with an iTero Element was performed. The resulting “stl file” allowed for a virtual wax-up plan within Exocad software.

After verification of the esthetic and functional parameters, the veneer files were converted for milling using Hyperdent Compact and milled from GC Cerasmart CAD blocks, shade B1 HT on the Versamill 5X-200.

All six veneers were milled in less than 45 minutes and the resulting intaglio surfaces were lightly sandblasted and etched with hydrofluoric acid. The veneers were trial fitted on the tooth surfaces.

Once complete etch and bonding agent was applied, the veneers were luted with Gradia CT (clear) hybrid restorative, which was heated in a ribbon tube (Centrix) to dramatically reduce viscosity.

Excess was removed prior to polymerization of the luting composite and the margins were polished flush with the natural tooth surface with disks and rubber abrasives (Brasseler USA). The patient returned in 1-week for post operative evaluation and adjustments.

Summary

This 21st Century workflow utilizing digital scanning and Exocad design software, coupled with Hyperdent and the precise and powerful Versamill 5X 200 milling machine, provided Friedman Dentistry with total control of the functional and esthetic results. As a result of our training and support from Axsys Dental Solutions, this patient treatment required minimal time and cost.