Cometic Composites Restorations

130 Rating(s).


Posted on By Gregory Mark In Esthetic Therapy (General)

Patient wants to improve her smile. She had old bonding and recurrent caries. We design a smile hoping she will go for the porcelain restorations, but due to finance she decided to go for composite restorations. Wax up was done by my technician and brought her for Mock up. We decided to schedule several appointments to accommodate patient's needs. I used Empress Direct B1 Enamel and Dentin, Cosmedent Opaquer and Tints. Gregory




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14 Comments

Hi Greg;
Your composite skill is obvious...Your lab technician did not follow the rules of proportionality: The centrals are about 8x8 or 9x9. The centrals should have been 1-2 mm longer which is why a 5 min direct resin mockup in the mouth to definitively locate the correct length would have been a great guide for the wax up.

For some reason dentists are reluctant to determine the correct incisal length and position in the mouth; this is something that we do everyday with dentures but not restorative dentistry.
Best regards,
gerald


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Thank you Gerald! My patient is still thinking that they are too long. Gregory


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Gregory;
God does not make a 9 mm tooth...NO exceptions and that is what I tell my patients. If some DENTISTS do not know the rules of proportionality who can we expect patients to know? Patients are entitled to want ugly but that does not mean that I must give it to them.

The Direct Resin Mockup not only gives me the final treatment parameters and gives the patient a preview of the completed treatment. If the patient does not like my Mockup, I then know that I do not want to be involved in their treatment. My patients are most fortunate to have 78 other dentists in my town that they can have perform their treatment.
Regards,
gerald


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I agree with you. I usually leave the restorations how I feel should be right and let the patient wear them and only then to make a decision. In her particular case she would end minor crown lengthening procedure. She will come back for lower jaw next time. Gregory


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Dental Care is very important. People do realize this! but it is often too late for them. Great Post.
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Mark, quite a nice case. End result seems to me very balanced. Smile and tooth lenght should be, IMO, related to the frame, lips on this case. And lower lip profile suggest not too long central incisor. Have a question for you: do you think you will need a future program here for composite maintenance ? Thanks for sharing. Armando


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Thank you Armando! I usually bring them every 3 months for recare. I always tell my patients if they change their mind and wan to have porcelain restorations we can slowly transform her smile if she has financial difficulties and treat these restorations as a training ones to check her occlusion. Gregory


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Gregory, It is a nice result but Gerald's comments are correct with sizing...especially the left lateral and facio-gingival of the first bicuspids that need cosmetic contourning. I feel you can create better horizontal proportion if you reshape the disto-labial of the left lateral and take away some of the labio-gingival curve of the bicuspids. I would not reduce length at all.


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Thank you! Just finished the lower jaw. Can you comment more on finals. Gregory


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Gregory

Does your lab have the ability to do this in a digital world if so you could actually make a couple of different sets of mock ups. I know Gerald said that you can do this in the mouth in five minutes which to my knowledge is true however you could actually wax it up in several different ways in a digital world and as Dr. Goldstein stated you can do all the additions and take away and then determine what looks Most fit into the patient's face similar DSD concept

Cheers,

Richard


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Yes , I can do all digital. Gregory


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I agree with you. I usually leave the restorations how I feel should be right and let the patient wear them and only then to make a decision.


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Do not use 8-9 mm teeth.


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