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QUARTER 2 | 2014 | CERECDOCTORS.COM | 35
any definitive treatment, including
tooth preparation. In my practice, I
refer to this stage as the “temporary
prototype,” and I will not move forward
with tooth preparation until the patient
is completely satisfied with the shape,
symmetry and proportions of his or her
new temporary smile.
In this case, the patient wore the proto-
type mock-up for several days to evaluate
theestheticsbeforereturningfortheprep-
aration appointment. After she gave her
final approval of the prototype mock-up, I
then used the same intra-oral mock-up as
a reduction guide for the definitive tooth
preparations.Sincetheprototypemock-up
established the desired ideal external
outline formof the proposed final restora-
tions, specially designed depth-cut burs
(Dr. Robert Winter Restorative Design
bur kit, Brasseler USA) were used to
uniformly reduce her teeth. These depth
cuts were used to precisely account for
the desired form and position of the final
ceramic restorations, ensuring an even
thickness of ceramic material across the
smile (Fig. 6).
After initial rough-prepping of all the
teeth using the depth cuts as the guide,
sectioned templates derived from the
diagnostic wax-up were then used to
confirm uniform reduction for an ideal
ceramic outcome, taking into account
the high degree of shade improvement
this patient requested (Fig. 7).
3
4
5
6
arches and a total of 21 single units.
With the definitive restorative treat-
ment plan agreed upon, the approved
diagnostic wax-up was then templated
using a VPS putty matrix (Reflection,
Patterson Dental) with a VPS wash
(Aquasil Ultra XLV, Dentsply-Caulk)
(Fig. 4). The patient’s unprepared teeth
were then spot-etched with 37 percent
phosphoric acid (Patterson Dental) and
selectively brushed with primer/adhe-
sive (Optibond XTR, Kerr), while provi-
sional Bis-acryl material (Structur 3,
Voco) was injected into the template and
placed over the patient’s natural teeth
to create an intra-oral overlay mock-
up. After allowing the material to set, I
then removed the template and verified
proper esthetics, phonetics and occlusal
function in this mock-up stage (Fig. 5).
Once again, it is critical at this juncture
to get patient approval before beginning