Page 16 - CEREC Q4 | 2014

14 | CERECDOCTORS.COM | QUARTER 4 | 2014
| | | S K R A M S TA D
CASE STUDY #2
The second case we are going to analyze
and treat is a badly chipped tooth #8 and
an old PFM on tooth #9 (Fig. 14). This
particular patient had been deferring
the treatment for years and decided to
move forward this year. Since he trav-
eled for business, we decided do a direct
mock-up in the mouth based on our
Photoshop analysis, and plan and create
same-day restorations.
Looking at the smile, it was evident
that tooth #9 was too wide. However, the
lengthof the toothwas ideal (basedon lip-
at-rest photos not shown) and I decided to
use that length as a reference point for the
digital plan. When looking at the overall
measurement of tooth #8 and #9, it was
determined that 8.5 mm to 9.0 mm width
for each central incisor was ideal based on
the 11 mm length used as a reference. We
again calibrated digital rulers in Photo-
shop Elements to start this plan (Fig. 15).
After determining the midline and the
length, we overlaid a digital template
for #8 and #9 over the top of the picture
(Fig. 16). These templates can be created
on your own based on tracings of ideal,
symmetric teeth or wax-ups. They serve
as a guide for “golden proportions” and
help digitally mock up the teeth for both
the patient and as a guide for our intra-
oral mock-up.
Just as in the first case, we will outline
the tooth with the Lasso Tool in Photo-
shop. However, this time the template
itself and not the tooth is outlined. This
allows us tomorph the existing tooth to the
confines of the template we chose for the
case (Fig. 17). From there, we can mirror
#8 over #9 to complete the digital mockup
for the patient (Fig. 18). This mock-up
served two purposes: giving the patient a
wonderful representationofwhat thegoals
of the case were; and allowing us to take
measurements using our calibrated digital
ruler to transfer the design into the mouth
with composite (Fig. 19). Once the intra-
oral mock-up has been completed, this is
just a simple bioscopy case. The case was
completed same day usingVitaMKII feld-
spathic porcelain (Fig. 20).
Smile design is a rapidly evolving field,
and I expect that companies like Sirona
will develop fully integrated software
for this in the future. In the meantime,
simple techniques with inexpensive
software can be utilized to create digital
smiles that not only serve to create value
for the patient, but also guide the dentist
on how the case should be treated.
This article glossed over the
Photoshop Elements software and some
of the templates used (rulers and “golden
proportions”). There is a full catalog of
videos released in concurrence with this
article on www.cerecdoctors.com that
explain a detailed, step-by-step process
on how to create these digital mock-ups.
The templates will also be available in
the Download section of the site.
Go to the cerecdoctors.com Digital
Library for a complete video series
pertaining to this article.
Fig. 14: Pre-op
Fig. 15: Calibrated rulers and midline
Fig. 16: Templates over-layed to correct
dimensions
Fig. 17: Morph tooth #8 to template
Fig. 18: Final digital mock-up
Fig. 19: Final intraoral mock-up
Fig. 20: Final restorations
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