CAD0110

I 17 case report _ smile design I CAD/CAM 1_2010 Athersecondconsultationappointment,wecon- firmed the smile design and length combination she had previously selected by showing her a diagnostic wax-up of her upper and lower teeth (Fig. 6). Matri- ces were fabricated from the wax-ups before this appointment and used to make an upper and lower Slip-On Smile right on the patient’s teeth. We loaded the matrices with an A-1 bis-acryl temporary material (examples are Temphase, Kerr; Integrity, DENTSPLYCaulk;andPERFECtempII,DiscusDental)— andseatedtheminthemouth.Afterthematerialwas set, the matrix was removed; remaining on her teeth was a new smile. We took a series of photographs with the Slip-On Smile in place and the patient was ecstatic. She was abletoseeandfeelwhatherteethwouldlooklikebe- forecommittingtoanydentalwork(Fig.7).Thepatient wastrulyamazedbythisandwantedtowearthesmile hometoshowherhusband. Though the patient had loved the selected smile design and cosmetic image, she was not convinced aboutpursuingthistreatment.Thisdemonstratesthat the Slip-On Smile is an important part of treatment presentation. She accepted the treatment as soon as shecouldexperiencehernewsmilefirsthand.Webe- ganhertreatmentwithacombinationofin-officeand at-home whitening. The incisals of the canines and bicuspids showed acceptable results. We used this as a base shade, planning to make the lower veneers even lighter towards the front and the upper veneers slightlylighterthanthelowers.Asplanned,teeth#6to 12werepreparedforMicroveneersinordertopreserve as much natural, healthy tooth structure as possible. Tooth #5 had an existing crown that the patient wishedtoreplacetomatchtooth#12;thus,thetooth waspreparedforazirconiumcrownatthesametime. Digital photographs of the preparation shades were takenforourceramicartist(Fig.8). Once the preparations were finished and refined, it was time to provisionalise the teeth. While an assistant loaded a tray with alginate, hydrocolloid (Dux Dental) was expressed over the prepared teeth for an impression. Then the alginate-filled tray was seated in the mouth, directly onto the hydrocolloid. Afteraminuteandahalf,theimpressionwasremoved with a snap and handed off to an assistant to pour. In the laboratory, the impression was disinfected and dried. Next, Mach-2 PVS (Parkell) was dispensed into the impression to pour up the model on a vibrator. A fast-setting bite registration material (SuperDent, Darby Dental) was then placed directly onto the Mach-2foramodelbase. In less than two minutes, an accurate, instant silicone model was ready on which to fabricate a provisional—all of which was completed outside the patient’s mouth by an assistant. Using the matri- ces made from the diagnostic wax-up and approved by the patient in her Slip-On Smile, the provisionals were fabricated. Fig. 5_Cosmetic image. Fig. 6_Diagnostic wax-up and putty matrices. Fig. 7_Slip-On Smile full face. Fig. 6 Fig. 7 Fig. 5