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41
and wheels. The decision was made to
use the Impulse blocks. Because we had
a mixture of restorative substrates, we
needed a material that had some opacity
to cover the zirconium abutments but
still allowed for translucency at the
incisal edges.
Once the abutments were received
from InfiniDent, the TiBase and abut-
ment were bonded together. The TiBase
was sandblasted to allow for better
bonding of the zirconium to the tita-
nium. The two pieces were bonded
together using Multilink Implant. Then
the metal TiBase that was sticking out of
top of the abutment was trimmed back
and modified (Figs. 15 and 16). At this
point, the abutments were placed in the
mouth with the other restorations and
then scanned to get a final design. This
could be done in Biocopy if we wanted to
keep the screw-retained temporaries in
while we placed the other restorations.
I decided to see what the design would
look like if I went with Bioindividual.
The patient then returned for the final
seating appointment. She was anesthe-
tized and the temporaries were removed.
The restorations that had already been
milled were tried in and final contours
were shaped with diamond burs. The
abutments were then tried in as well.
Then, retraction cord was placed, and
the abutments were scanned with
the restorations in place. The crowns
were designed for the abutments and
milled. They were then tried in with the
other restorations to make sure all the
contours, lengths and angulations were
in order. The occlusion was verified and
excursive movements were checked.
The restorations were then taken back
to the lab and characterization was done
with diamond burs. Developmental
grooves, perikymata and other minor
characterizations were done. Then the
restorations were stained, glazed and
fired. Since the impulse blocks are a
value system, instead of the traditional
Vita system, there are no direct corre-
lating stain colors. Since we were using
the impulse V1 blocks, adding a little B1
at the cervical gave it a bit more satura-
tion of color and some warmth. The B1
was also placed in the developmental
grooves to give some depth. The white
characterization stains were placed on
the incisal edges and then drawn down
to highlight the line angles and create
characterization. Incisal blue stain was
placed on the lingual towards the incisal
edge to give a subtle translucent halo. All
the stains were done so that they are not
highly noticeable once the restorations
were fired. This requires not only very
small amounts of stain, but to make sure
that they are blended to allow for subtle
transitions.
After characterization and staining
were done, the restorations were fired
on the full-length e.max cycle. Impulse
blocks cannot be fired on any of the
shorter cycles. It really did not matter
in this case since we were firing eight
restorations at one time. After the resto-
rations were cooled, they were cleaned
and put in place one more time with
Variolink Veneer try-in paste value zero.
The overall esthetics were then evalu-
ated, and the patient was given time to
really look them over and make sure she
was happy. An easy way to tell if they are
pleased is if they start crying from happi-
ness. That is what happened in this case.
The restorations were etched for 15
seconds with 9 percent HFl acid. Mono-
bond Plus was placed on the inside of
all the restorations and let to sit for
one minute. It was then air dried for
10 seconds to form a nice, thin layer of
ceramic primer.
The teeth were isolated with an Optra-
Gate and cotton rolls. All of the prepa-
rations were cleaned with Consepsis
and rinsed. The teeth were etched for
20 seconds and then thoroughly rinsed
for 10 seconds. Excite was placed on the
teeth and scrubbed in for 15-20 seconds.
Themanufacturer says scrub for 10; I like
to scrub for 10, air thin, and apply more
for another 10 seconds, then air thin
again. The Excite was then cured for 10
seconds on each tooth. Variolink Veneer
cement medium value zero was placed in
the restorations and seated. The excess
was cleaned up, then the restorations
were cured for 20 seconds both buccal
and lingual. Any residual cement that
was left over was removed with an IPC
instrument and then refined with fine
fluted carbide finishing burs.
17
Fig. 17: Final result
I always have the patient return in
one week for final photos and occlusion
refinement. The beauty of having the
patient wear the temporaries and work
out the occlusion and esthetics is there
are very few refinements needed at the
one-week post-op.
The patient and her mother came in
for the final appointment. The patient
was so happy with her new smile (Fig.
17) that both she and her mother gave me
a big hug and had tears in their eyes. She
also brought me a lovely gift and a card
with these words: “Nobody has ever and
will never be able to have the amount of
impact on my life they way that the both
of you do.”
Those words were worth every penny
I didn’t make.
For questions and more information,
Dr. O’Bryan can be reached at
