CDE0211

_malocclusion according to Angle’s classification; and _reverse smile curve. Contemporary aesthetic dentistry can correct most of these defects utilising a simple, compre- hensive, MI approach that places equal empha- sis on patient psychology, health, function and aesthetics.Eachoftheseaspectsoftreatmentcon- siderationcanbebestanalysedusingthedecision- making system of the Smile Design Wheel, which includes each individual aspect as a continuum (Fig. 2).6 _Smile design with all-ceramic, partial coverage restorations All-ceramic, partial coverage adhesive resto- ration (porcelain veneers, inlays and onlays) is considered one of the MI treatment options in MICD treatment as opposed to placing complete coverage restorations (full crowns) that require significantly more tooth preparation. In certain situations, no-preparation veneers may be placed but only if the final aesthetics will not be compro- mised by the added thickness of the labio-lingual restorative material that a no-preparation veneer creates. Adhesive restorations conserve tooth structure because less tooth preparation is required for mechanicalretentionoftherestorationwhenpor- celain-enamel adhesion is employed (Fig. 3). Less mechanical retention preparation is required to stabilise a bonded porcelain restoration in com- parisonwithanon-bondedrestoration.Thechem- icaladhesionbetweenetchedporcelainandetched enamel provides increased retention. Less tooth preparation can minimise untoward pulpal re- sponses that frequently result when a vital tooth is prepared for full coverage. Another significant patient benefit of employ- ing adhesive restorations is that treatment time is usually shortened to only two visits: _first visit: partial coverage preparation, provi- sionalisation that incorporates the desired smile design improvements, and one inter-occlusal registration; _second visit: porcelain try-in, enamel adhesion, occlusal adjustments and case finishing. During the second visit, the clinician cannot perform any insertion occlusal adjustments prior to bonding these very brittle restorations in place, as they cannot safely withstand any occlusal al- terations without introducing the possibility of restoration fracture. _Shortened treatment times can introduce occlusal errors Howeverbeneficialtheseshorttreatmenttimes may be for the patient, they may have two poten- tially problematic post-insertion results: Fig. 3_Veneer preparations conserve tooth structure compared with full coverage crowns. Fig. 4_Articulated casts require remounting to ensure minimal spatial distortions at case delivery. Fig. 5_Articulating paper markings do not measure occlusal force by paper mark appearance, regardless of their depth of colour, mark size or shape. Paper markings cannot determine tooth contact timing sequences either. Fig. 6a_T-Scan III recording handle with USB connection. Fig. 6b_T-Scan III desktop. I 07 MICD _ occlusal force management I cosmeticdentistry 2_2011 Fig. 6a Fig. 6bFig. 5 Fig. 4Fig. 3