CDEN0210

26 I I case report _ aesthetic rehabilitation as the curvature of lower lip—evaluation of aes- thetics provided by the provisionals at this stage is crucial in guiding the patient to the amount of display necessary for an aesthetic smile. The provisional crowns were constructed with Protemp 4 (3M ESPE), a bis-acrylic resin composite. Allcontourswerekeptcurvaceousandsmoothwith space made available for the patient to use inter- dentalcleaningaids,owingtotheprovisionalsbeing splinted together. The patient was given instruc- tions on oral hygiene during the provisional phase and was asked to return in two to three day’s time for final approval. Irecommendthisdelayedapproachofassessing the provisionals, as patients are not pressured into deciding whether they like the provisionals on the dayofpreparation.Patientsareoftenanaesthetised and suffer the associated facial palsy and cannot adequately assess aesthetics at this time. The pa- tient will also often ask friends and family about the proposed changes and the extra time allows patients to accustom themselves to their new look. If the provisional restoration requires modifi- cations, it can be adjusted and an impression taken to communicate the changes to the ceramist. 10. Cementation:Thecrownswerereceivedbackfrom the laboratory and tried in the mouth. I prefer not touselocalanaestheticforthepatienttoapprove thefinalaestheticspriortocementation.However, iflocalanaesthesiaisrequired,analternativetech- nique is to use the AMSA local anaesthetic block technique so that the injection achieves pulpal anaesthesia of the central incisors through the second premolar without collateral numbness of the face and facial muscles of expression. This is best achieved with a computer-controlled injec- tion system (The Wand, Milestone Scientific) that delivers a virtually painless palatal injection. Once the patient is happy and approves the final aesthetics,therestorationsarepreparedforcemen- tation.Thepatientisaskedtoreturntotheofficeone week later in order to allow a final examination of the aesthetics, phonetics and occlusion. _Conclusion The aesthetic rehabilitation of a patient with functionally compromised dentition frequently in- volvesamultidisciplinaryapproach.Propersequence and planning, involving periodontal, orthodontic, aesthetic and restorative treatment, is required with good communication amongst the whole team— the patient, ceramist, the treating clinicians. Provisionalisation is a significant factor in achieving a successful aesthetic outcome for both the patient and the dental team. It permits the patienttopreviewtheirfutureteeth,allowingthem to assess the aesthetic and functional changes. Invaluable information can be gained regarding aesthetic factors, including incisal display, bucco- lingual position of teeth, smile line and shade, and functional criteria can be assessed with phonetic and occlusal changes._ cosmeticdentistry 2_2010 Fig. 9_Palatal view of all-ceramic crowns. Fig. 10_Frontal view of completed all-ceramic crowns. Dr Christopher Ho received his Bachelor of Dental Surgery withfirst-classhonoursfromthe University of Sydney,Australia. HereceivedaGraduateDiploma inClinicalDentistry(OralImplants) andaMaster’sdegreeinClinical Dentistry (Prosthodontics) with distinction from Kings College London.Dr Ho is a sought-after lecturer on aesthetic and implant dentistry internationally and withinAustralia.He lectures at several universities inAustralia and the UK.He is a faculty member of the Global Institute for Dental Education. Dr Ho has a referral-based private practice in prosthodontic and implant dentistry in Sydney. cosmeticdentistry _about the author Fig. 10Fig. 9

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