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34 | CERECDOCTORS.COM | QUARTER 2 | 2014
a successful smile makeover can be
an extremely rewarding dental experi-
ence, both for the dentist and the patient.
Making the leap from treating single
teeth to rebuilding full smiles can trans-
form your practice and your patients’
perceptions of modern dental care.
While the potential reward is high, the
corresponding negative risks sometimes
keep us from challenging ourselves with
larger, more complex cases. This article
outlines a repeatablemethod for delivering
dramatic smile makeovers using CEREC
CAD/CAM technology, with an emphasis
onpredictable esthetics and function.
CASE STUDY
“Doc, I want a Hollywood smile!”
I love when patients have a clear
vision of what they want esthetically,
and I enjoy working with patients to
create their bright, newsmiles. Being the
architect of our patients’ dream smiles
can be a challenging task, but the results
can be life-changing for us and them. So,
when the following patient asked me
to create an “over-the-top, knock-out
smile” to match her gregarious person-
ality, I enthusiastically agreed.
In my practice, any conversation
about esthetics starts with patient
photographs and mounted diag-
nostic models. It is crucial to know the
patient’s expectations, as well as what
you can or cannot accomplish, BEFORE
beginning definitive treatment. So, with
those goals in mind, the following case
began with accurate diag-
nostic models and clinical
photographs. From these
fundamental records, I
Predictable Smile Makeovers
Utilizing CEREC
Repeatable Methods for Life-changing Results
C A S E S T U D Y | | | B Y R O S S E N F I N G E R , D . M . D .
stone (Denstone White, Heraeus) and
mounted on a semi-adjustable articu-
lator (SAM-3, SAMDental) (Fig. 3).
During the patient’s review of the
mounted diagnostic models and photo-
graphs at the consultation, she decided to
treat all the teeth in her visible smile line
instead of just restoring the broken ante-
rior teeth. Because of her high esthetic
requests and desire for an artificially
white and straight smile, she opted for a
full-mouth cosmetic reconstruction, and
her case evolved from the initial tenta-
tive plan of seven maxillary teeth to a
final treatment plan which included both
started evaluating her existing smile
and developing a visual plan of how the
patient wished to re-design her smile.
She presented with incisal edge wear,
enamel chipping, mal-positioned teeth
(Fig. 1) and a desire to create an artificial
“Hollywood” smile with an intensely
bright and square appearance. Taking
into account this patient’s esthetic
wishes, I developed a photographic
proposal of where I intended to position
her new upper teeth in relation to her
face, lips and smile line (Fig. 2).
The patient was ecstatic with the
photographic proposal of her new smile,
so the next step involved converting that
two-dimensional schematic into a test-
able three-dimensional mounted diag-
nostic wax-up. Preliminary impressions
were made with VPS material (Aquasil
Ultra Heavy and XLV, Dentsply-
Caulk), double-poured in Type-III die
Fig. 1: Pre-op smile
Fig. 2: Proposed new smile
Fig. 3: Mounted diagnostic models
Fig. 4: Putty/wash template
Fig. 5: Proposed new smile mock-up
Fig. 6: Guided depth cuts
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