RESTORATIVE CHALLENGE: The patient was unhappy with the staining and uneven bite of teeth #5-#13 (see Figure 1). He wanted brighter teeth and cosmetic restorations that would improve his smile and overall look.
Restorative team: Frank Kogel, master ceramist and owner, Kogel Dental Laboratories in Redlands, California and Dr. H. Klein, Colorado Springs, Colorado, formerly of Laguna Beach, California
Treatment plan: The dentist suggested laser bleaching the patient's teeth to lighten the underlying color resulting from enamel hyplasia and placing ceramic veneers made from Aurident's Press-i-Dent Ceramic and Radiance Porcelain to improve his teeth and smile. The dentist contacted Kogel Dental Laboratory to fabricate the necessary veneers and to assist the patient in understanding and visualizing the final look.
Case study: The patient's teeth were bleached and impressions were taken. Frank Kogel fabricated a waxup using Yeti diagnostic wax to show the contour, anatomy and color of the actual ceramic restoration. Tooth morphology was modified in the waxup to align the bite and occlusion and incorporate cosmetic changes. The incisals of #7 and #11 were extended so that they followed the contours and guidelines of the Golden Proportion Rule, which states that the frontal view of an anterior arrangement should vary by an approximate ratio of 1.5:1 in length and width from tooth to tooth. The patient was shown the wax models, and upon his approval, his teeth were prepared to a depth of approximately 0.7mm and impressions were taken again.
In the laboratory, Kogel made master models using the presentation diagnostic waxup as a guide. He fabricated the die models from low-expansion stone suitable for pressable ceramics. Final waxups were completed using ash-free pressing wax. The finished units were then sprued with 8-gauge ash-free wax and invested in Aurident's Auri-i-Vest Investment and prepared for rapid casting using the Auri-i-Vest instructions (see Figure 2). Veneers were fabricated using Aurident's Press-i-Dent Pressable Ceramics' California White shade. This dense bleached shade was chosen because of its ability to hide the remaining stains on the patient's natural teeth that the bleaching didn't completely remove. For the wax burnout and pressing times, temperatures and conditions, Kogel followed the instructions in the Press-i-Dent Pressable Ceramic's manual.
After pressing, Kogel removed the veneers from the investment by lightly blasting with 50-micron glass beads using minimal pressure and cleaned off all investment in an ultrasonic cleaner. The veneers were cut from the sprues using a diamond wheel and fitted to the model. After the first bake, a light layer of Radiance nano-particle dentin modifier, in shade A, was applied to reduce the brightness and add chroma. The incisals were built up using Radiance Incisal #1 and Highlighter Value Enhancer and Incisal Modifiers were added (see Figure 3). The veneers were given a second bake, ground to the final shape using diamond burs and mechanically polished with a proprietary diamond compound. Both technicians and dentists have commented that the Press-i-dent and Radiance systems mechanically polish extremely well.
Dr. Klein showed the veneers to the patient and placed them on the teeth for the patient's final approval. He made adjustments and applied a final polish in the office before bonding. The patient was very satisfied with the results (see Figure 4).