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QUARTER 1 | 2014 | CERECDOCTORS.COM | 43
increase in her vertical dimension. Only
at this point in time was a diagnostic
wax-up completed with an anterior
guidance occlusal scheme to the desired
new restorative vertical dimension of
occlusion. The diagnostic wax-up was
critical to best predicting the realistic
cosmetic improvement the patient could
expect. It was also useful in producing a
stent from which chairside provisional
restorations could be made. The patient
then presented for a lengthy treatment
visit completed under oral conscious
sedation in which both the maxilla and
mandible were prepped entirely.
The preparation design for each tooth
was dictated by both the desire to main-
tain as much healthy tooth structure as
possible and keep the previous restora-
tions present.
Keeping in mind that the desired
rehabilitation would increase the
patient’s vertical dimension of occlu-
sion, three acrylic jigs were made to this
new position (Fig. 3). The right side of
both arches was then prepared, and
the corresponding acrylic jig relined
onto the preparations to ensure the
desired restorative vertical dimension
of occlusion was maintained. The left
side of both arches was then prepared
and the corresponding jig relined onto
the preparations to the desired restor-
ative vertical dimension. Chairside
provisionals were then fabricated from
Luxatemp (DMG) using putty stents of
the diagnostic wax-up. The previously
discussed acrylic jigs were used during
the fabrication of the chairside provi-
sionals to ensure maintenance of the
new vertical dimension of occlusion.
The patient was then dismissed without
any complications.
Over the next several weeks, the
patient was evaluated for occlusal
harmony, proper phonetics and overall
cosmetic satisfaction with her “new
smile.” Enough cannot be said about
the importance of having the patient
functionally comfortable and operating
within her entire envelope prior to
proceeding with treatment.
The patient then presented for an
appointment to complete a full-arch
Omnicam scan of the maxilla. A full-arch
Biocopy scan of the patient’s existing
chairside provisionals was first made
to digitally record their confirmed
cosmetics and occlusion with great
accuracy (Fig. 4). The teeth preparation
designs were then rounded, smoothed
and finalized to ideal for CEREC treat-
ment. Various tools were used to best
achieve gingival retraction for optical
recording. Specifically, a diode laser was
used in some areas to trough hyperplastic
tissues. In other areas, retraction cord
was placed to allow for margin visualiza-
tion. Lastly, hemostasis was controlled
for with 3M retraction paste (3MESPE).
Once each margin was clearly visible,
the full-arch Omnicam scan of the
maxilla was made with an OptraGate
(Ivoclar), and the Isolite System in
place to improve the ease of the digital
recording process (Fig. 5). At this time,
Sirona’s 4.0-level inLab software was
used to “stitch” the digital scan of the
chairside provisionals with that of the
prepared teeth to virtually confirm
adequate occlusal reductions had been
made (Fig. 6). Once the optical impres-
sioning was completed, all remaining
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and restore health to her dentition. This
proposal — full-mouth cosmetic reha-
bilitation — was immediately accepted
by the patient, given her high degree of
motivation.
Treatment started much in the same
manner as with any full-mouth recon-
struction — with the making of diag-
nostic impressions and records for case
evaluation andultimately the fabrication
of an esthetic diagnostic wax-up (Fig. 2).
Review of the mounted diagnostic casts
revealed treatment would benefit from
increasing the patient’s vertical dimen-
sion by 2 mm to idealize the amount of
restorative space available. The patient
was given a removable bite splint appli-
ance which she wore for six weeks to
confirm she could tolerate the planned
Enough cannot
be said about the
importance of having
the patient functionally
comfortable and
operating within
her entire envelope
prior to proceeding
with treatment.
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