CDEN0210

I 25 case report _ aesthetic rehabilitation I cosmeticdentistry 2_2010 4. Gingival recontouring: A 940 nm diode laser (EZlase, Biolase) was utilised to improve soft- tissue aesthetics. Periodontal bone sounding was performed to ensure that biologic width wasnotinvaded.Gingivaltissueswerethenlased to improve the gingival contour, symmetry and gingival zeniths. 5. Preparation: It is recommended that an axial reductionof0.8to1.0mmandanocclusalreduc- tion of 2.0 mm be made, as ceramic materials require a certain thickness to withstand masti- catory and para-functional stresses. Chamfers or 90° rounded shoulders are recommended for finish lines in order to firstly provide sufficient bulkatthemarginsandsecondlyallowthetrans- ference of stresses around the margins. In order to minimise stress concentration within the restoration, all line angles should be rounded, all sharp edges smoothed and boxes, grooves and ‘butt’ type shoulders are contraindicated. 6. Impression procedure: A double zero retraction cord (Ultrapack #00, Ultradent) was placed into the gingival sulcus as a first cord. A retraction paste (Expasyl, Pierre Rolland) was then placed over the first cord. The correct use of this retrac- tion paste should see blanching of the gingival tissues as the paste is extruded into the gingival sulcus. An impression was made with a polyvinyl siloxane material (Imprint 3, 3M ESPE). 7. Maxillo-mandibular relations: The Kois Dento- FacialAnalyzerSystemregistersandtransfersthe patient’s occlusal plane and tilts in the occlusal planeinthreeplanesofspacetothearticulatorre- lated to an average 100 mm axis-incisal distance. This allows orientation for aesthetic positioning of the anterior teeth in relation to the midline of the face and ensures correct orientation of the incisal plane. 9. Provisionalisation: The provisional restorations are duplicated from the diagnostic wax-up that incorporates the proposed changes. It allows patients a ‘test run’ of the final result by allowing them to see a preview of the planned result. This is an essential step in the planning process. The aims of provisionalisation are: a. Health: pulpal protection and periodontal health and gingival stability; b. Function: the assessment and indication of any occlusalandphoneticproblemswiththeproposed changes—the pronouncing of ‘V’ and ‘F’ sounds should create a light contact between the central incisor and the wet-dry line of the lower lip; c. Aesthetics: the assessment of the basic shade to be chosen, incisal edge display, form and shape of teeth, dental midline location, lip support, paral- lelismofincisalplanetointer-pupillarylineaswell Fig. 5_Crowns sectioned in order to allow insertion of Christensen Crown Remover (Hu-Friedy) for removal. Fig. 6_Use of Expasyl for haemostasis and retraction. Fig. 7_Use of Kois Dento-Facial Analyzer to align midline and incisal plane. Fig. 8_Two to three days after provisionalisation, for review of provisionals to ensure approvalof shape, colour and other desired changes before final crowns are made. Fig. 6Fig. 5 Fig. 8Fig. 7