Dental Tribune UK Edition, October 4-10, 2010, No.24 Vol.4

The new Luxatemp® Star offers outstanding results for break resistance and flexural strength! The newest generation of DMG’s top material Luxatemp® scores even better: excellent stability, maximum fit and reliable long-term color stability. No wonder experts recommend it. Find out more at www.dmg-dental.com/luxatemp-star Stunningly beautiful temporaries with proven durability: For a look that’s hard to beat. The new Luxatemp Star.® NEW! The new Luxatemp Star offers outstanding results for break resistance and flexural strength! The newest generation of DMG’s top material Luxatemp scores even better: excellent stability, maximum fit and reliable long-term color stability. No wonder experts recommend it. Find out more at Dental Showcase in London, booth H15 or www.dmg-dental.com/luxatemp-star Stunningly beautiful temporaries with proven durability: For a look that’s hard to beat. The new Luxatemp Star. AZ_LxStar_DentistryGB_1009.indd 1 22.09.10 10:06 lished a collapse of the bicus- pids in the buccal corridor. Fur- thermore, the axial inclinations, irregular gingival margins, and incisal edges created a down- ward tilt to the patient’s right due to tooth positioning. Close- up imaging showed healthy gin- gival tissues as well as a weak- ened right central incisor from a large composite (Fig 2). Findings A full clinical examination with radiographs and mounted mod- els revealed the following: • Biomechanically, the majority of her teeth remained strong de- spite previous dental care. • Periodontally, soft and hard tissues were healthy. • Occlusally, load testing was normal (after muscle relaxa- tion) and there was obvious CR-CO anterior-vertical slide due to a premature contact at tooth #30. • Esthetically, the width-to- length ratio of the upper cen- trals was 1:2, far from the ideal range of 0.75:1.0. Tooth shade was a Vita A2. Treatment Plan Given the patient’s previous his- tory and her desire for minimal- ly invasive dental care, a con- servative strategy was devised that would allow us to correct the problems and causes in a “multi-tasking” manner: •Muscle and bite therapy with a Tanner appliance, followed by careful equilibration aided by the T-scan (Tekscan System; South Boston, MA) •Three-dimensional wax-up on a Stratos articulator (Ivoclar Vi- vadent; Amherst, NY) (Fig 3) • Home bleaching of the lower teeth with Opal- escence 15 per cent (Ul- tradent; South Jordan, UT) • “Closed flap” periodontal modification with the Waterlase ErCr: YSGG (Biolase Technol- ogy; San Clemente, CA) while the first three items were being accomplished (the combina- tion of these four steps was a tremendous time saver and also allowed us to carefully monitor progress on a weekly basis) • Definitive restorative care with porcelain veneers and a crown on tooth #8. No tissue necrosis or sig- nificant bleeding occurred as a result of using the laser’s rela- tively lower settings. Treatment At the initial closed periodontal lift, the ErCr-YSGG laser was used in three modes (gingival sculpting, osseous recontouring, and bio-stimulation). Prior to an- esthesia, the desired framework was planned and outlined using a fine marker (Fig 4). Further- more, a stick-bite was used, not only to establish an ideal incisal plane, but also to properly align the gingival margins (Fig 5). With the settings at 2.0 Watts (W), 20 pulses per second, 20 per cent air, and 20 per cent water, a G-6 tip (600µ in di- ameter) was used to shape the labial gingival region. No tissue necrosis or significant bleeding occurred as a result of using the laser’s relatively lower set- tings. All areas were “sound- ed” using a periodontal probe (Fig 6). At the facial margins, os- seous sculpting required great precision in order to maintain a 3-mm DGC. A specially tapered T4 tip (400µ in diameter) was used at a 25 per cent higher watt- age of 2.5W. Prior to usage, the tip was measured and marked to 3 mm in order to maintain controlled adjustments within the gingival sulcus during perio probing movement of the tip (Fig 7). The resection was smoothed with a 7/8 curette (Fig 8). Using low-level laser therapy at a set- ting of 0.25 W, a decrease in the release of inflammatory hista- mine and increased fibroblasts for junctional epithelial growth was achieved by “frosting” the outer epithelium and injection sites (Fig 9). The patient was placed on a vigorous home-care regimen (Oxygel, Oxy-fresh; Coeur d’Alene, ID) and closely monitored for a ‘A conservative strategy was de- vised that would allow us to correct the problems and causes in a “multi- tasking” manner’ page 29DTà 27ClinicalOctober 4-10, 2010United Kingdom Edition