RESTORATIVE CHALLENGE: The patient was unhappy with the overall esthetics of her smile. She had a large diastema between teeth #8 and #9, both teeth were too long and disproportionate to her facial features, and tooth #8 was discolored. Composite restorations needed to be replaced. Also, the patient had been bleaching with limited effects and sought lighter teeth (see Figure 1).
Restorative team: William Zanin, The Cusp of Integrity, Wallingford, Connecticut and Dr. John Stevens, Willimantic, Connecticut
Treatment plan: The team decided on all-ceramic restorations for esthetic purposes, specifically a combination of pressable porcelain jacket crowns and veneers on teeth #6-11. Willi Geller Creation CP pressable ceramic was selected for its ease of use and because its controllable expansion guarantees optimal fitting. Ideal for inlays, onlays, facings and single crowns, the Creation CP pressable system is compatible with both Creation CC and Creation LF and delivers the same natural results.
Case study: Prior to treatment, Dr. Stevens took master and backup impressions of the lower and upper teeth and sent them to the lab along with a centric bite, an Artex Rotofix Facebow transfer stand and an interpupillary bite. He then contacted Bill Zanin to discuss his objectives and the patient's expectations and, after consulting pretreatment digital photos, they developed a treatment plan.
Zanin produced a diagnostic waxup of the prospective treatment and returned it for doctor and patient approval. Dr. Stevens began clinical procedures and fabricated temporaries. He then sent the laboratory pre-operative study casts, including a cast of the temporaries in place in the mouth, and returned the approved diagnostic waxups so the lab could begin fabrication.
Zanin fabricated full contour waxups. The Willi Geller Creation CP was pressed to full contour with B1 shading. The contour was then cut back with 2.5mm removed from the incisal edge, .75mm off the jackets and 0.5mm off the veneers. He used Willi Geller Creation LF porcelain for layering. The first layer placed over the B1 dentin core was a combination of various LF translucencies, including CLO, NT, PSO, HT52, and minimal amounts of TI5. Over this, an encapsulating layer of enamels was used to regulate the value, including S57, PSO and S58.
The restorations were first contoured using diamond rubber wheels and diamond abrasives and then with fine diamonds; they were then glazed. Next, Zanin polished them using flower pumice and a large amount of water. The surface was then touched up using diamond rubber wheels.
Zanin acid-etched the restorations with a mild acid solution. The acid was neutralized and the restorations were heat soaked at a low temperature to burn off any residual acid. Finally, the case was delivered for insertion and bonded in place. After completion, the patient was ecstatic over the results and even shed some tears of happiness (see Figure 2).
Contact information: Jensen Industries is the exclusive distributor of Willi Geller Creation Porcelain. Call 800-243-2000 or 203-239-2090; http://www.jensenindustries.com/">click here to visit the website.