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f CT page 1C play, form and shape of teeth, dental midline location, lip support, parallel- ism of incisal plane to inter-pupillary line as well as the curvature of lower lip. Evaluation of esthetics provided by the provisionals at this stage is crucial in guiding the patient to the amount of display necessary for an esthetic smile. The provisional crowns were con- structed with Protemp 4 (3M-ESPE), a bis-acryl resin composite. All contours were kept curvaceous and smooth with space made available for the patient to use interdental cleaning aids due to the provisionals being totally splinted together. The patient is given instructions on oral hygiene during the provisional phase and is asked to return in two to three days time for final approval. I recommend this delayed approach of assessing the provisionals as the patient is not pressured into deciding if she likes the provisionals on the day of preparation. The patient is often anes- thetized with associated facial palsy and cannot adequately assess esthetics at this time. Patients will also often ask friends and family about the proposed changes and the extra time allows the patients to accustom themselves to the new “look.” If the provisional restoration requires modifications, the provision- als can be adjusted and an impression then made for communication to the ceramist of the additional changes. Cementation. The crowns are received back from the laboratory and tried in the mouth. I prefer not to use local anesthetic for the patient to approve the final esthetics before cementation. However, if local anesthesia is required, an alternative technique is to use the AMSA local anesthetic block technique so that the injection achieves pulpal anesthesia of the cen- tral incisors through the second pre- molar without collateral numbness of the face and facial muscles of expres- sion. This is best achieved with a com- puter-controlled injection system — such as the Wand (Milestone Scien- tific) that delivers a virtually painless palatal injection. Once the patient is happy and approves the final esthetics, the resto- rations are prepared for cementation. The patient returned to the office one week later to allow a final examina- tion of the esthetics, phonetics and occlusion. Conclusion The esthetic rehabilitation of a patient with a functionally compromised dentition frequently involves a mul- tidisciplinary approach. The proper sequence and planning involving periodontal, orthodontic, esthetic and restorative treatment is required with communication between the whole team, from the patient and ceramist to the treating clinicians. The use of provisionalization is a significant factor in achieving a suc- cessful esthetic outcome for both the Do you have general comments or criti- cism you would like to share? Is there a particular topic you would like to see articles about in Cosmetic Tribune? Let us know by e-mailing feedback@ dental-tribune.com. We look forward to hearing from you! Tell us what you think! Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com Vice President Global Sales Peter Witteczek p.witteczek@dental-tribune.com Chief Operating Officer Eric Seid e.seid@dental-tribune.com Group Editor & Designer Robin Goodman r.goodman@dental-tribune.com Editor in Chief Cosmetic Tribune Dr. Lorin Berland d.berland@dental-tribune.com Managing Editor/Designer Implant & Endo Tribune Sierra Rendon s.rendon@dental-tribune.com Managing Editor/Designer Ortho Tribune & Show Dailies Kristine Colker k.colker@dental-tribune.com Online Editor Fred Michmershuizen f.michmershuizen@dental-tribune.com Product & Account Manager Mark Eisen m.eisen@dental-tribune.com Marketing Manager Anna Wlodarczyk a.wlodarczyk@dental-tribune.com Sales & Marketing Assistant Lorrie Young l.young@dental-tribune.com C.E. Manager Julia E. Wehkamp j.wehkamp@dental-tribune.com Dental Tribune America, LLC 213 West 35th Street, Suite 801 New York, NY 10001 Tel.: (212) 244-7181 Fax: (212) 244-7185 Published by Dental Tribune America © 2010 Dental Tribune America, LLC All rights reserved. Cosmetic Tribune strives to maintain utmost accuracy in its news and clini- cal reports. If you find a factual error or content that requires clarification, please contact Group Editor Robin Goodman at r.goodman@dental-tribune.com. Cosmetic Tribune cannot assume respon- sibility for the validity of product claims or for typographical errors. The pub- lisher also does not assume responsibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune America. COSMETIC TRIBUNE The World’s Dental Newspaper · US Edition Clinical COSMETIC TRIBUNE | May 20102C Fig. 3: Orthodontic treatment to upright tipped teeth and correct occlusal plane. Fig. 5: Crowns sectioned to allow insertion of Christensen crown remover for removal. Fig. 4: Gingival recontouring completed. Fig. 6: Use of Expasyl for hemastasis and retraction.