Page 36 - CEREC Q3|2013

34 | cerecdoctors.com | quarter 4 | 2013
therehabilitationofapatient’s
complete dentition is a very chal-
lenging process, requiring careful
planning and execution. In this
article, I would like to go over the
steps necessary to treat a full-mouth
reconstruction with a combina-
tion of chairside fabricated restorations
and teaming up with a lab for anterior
esthetics work. I will also go over two
methods tomake long-term temporaries
for evaluating occlusion and esthetics.
This type of case can certainly be done
completely chairside with the CEREC.
That being said, there are times we don’t
want to tackle a case strictly by ourselves.
There can be many reasons to want a lab
tohelpwith a case: the esthetics demands
of the patient may be beyond our capabil-
ities; the patient may not be able to sit in
the chair long enough to have 6-12 resto-
rations milled, or; you have a busy prac-
tice, and your time is better spent treating
patients. The following case has little bit
of all of these reasons.
Case Study
The patient is in her early 50s, and pres-
ents with a concernwith the erosion and
notching of her teeth. She has erosion of
the facial of her anterior and signs of
GERD’s erosion in the posterior (Fig.
1). Her occlusion is stable and she has
class 1 canine and molar relationship.
The occlusal view shows that there is
crowding in the maxillary and mandib-
ular anterior teeth (Fig. 2-3). A joint
and muscle exam proved
to be negative for any joint
derangement or myo-facial
pain. Gingival recession,
Maximizing Efficiency
and Esthetics
A Full-mouth Rehabilitation With CEREC and CEREC Connect
c a s e s t u d y | | | b y D a r i n O ’ B rya n , D . D . S .
was warranted and conservative
veneers/crowns for the anterior. The
crowding of the anterior teeth was
discussed, which led to a conver-
sation about doing orthodontics
to align the teeth to closer to ideal.
This suggestion was made not to
make the midlines match, but instead to
prevent the excessive preparation of the
lower anterior teeth that would be neces-
sary to align them if we were to correct
the crowding through restorative proce-
dures. The patient agreed to proceed
with Invisalign prior to doing restor-
ative care. The patient stated she did not
want to have really long appointments.
Because of this, we opted to do the poste-
rior teeth chairside and the anterior teeth
would be sent to a laboratory. This would
keep all of the appointments under three
hours and allow for cut back and layering
for better esthetics.
Records were taken for Invisalign
and sent to Align Technologies. After
receiving the aligners, the patient
proceeded to undergo aligner therapy.
This took approximately three to four
months. After this was done, new study
models, photos and a bite were taken.
The smile photo (Fig. 4) will tell us if
there is enough tooth structure showing
with a natural smile, and show the rela-
tion of the lower teeth. In this case, the
length of the central incisors is close
to what we want for a final outcome. A
little length can be added, but too much
and the patient will look like they should
be chewing down trees. An overlay
of the final plan is put over retracted
view of the teeth to help evaluate what
the esthetic plan will look like (Fig. 5).
with erosive lesions, was present in
most posterior teeth. After discussing
her condition and recommending endo-
scopic evaluation for GERD’s, we took
study models and photos for treatment
planning and consulting.
The patient returned to the clinic
for a consultation appointment. Upon
discussing the various options and
final esthetic and functional outcomes
the patient wanted, it was determined
that full coverage on the posterior
Fig. 1: Before Invisalign
Fig. 2: Mandibular crowding
Fig. 3: Maxillary crowding
1
2
3