C ase Report

EASY ESTHETIC MOCK-UP

www.ejournalofdentistry.com

Ahmad Bunashi DDS Prosthodontist, Farwania Dental Specialty Center Ministry of Health, Kuwait. Correspondence: Ahmad Bunashi DDS Bayan 72053 State of Kuwait. Email: drbunashi@gmail.com ABSTRACT Comunicting anticipated results between dentist and patient is impairative for successful veneer treatment. This article describes a technique that allows for proper comunication of eshtetic result with ease . Keywords: Esthetics, Mock-up, Veneers, bis-acrylic material.

Introduction: Veneers play a major role in esthetically improving teeth in dentistry. They improve esthetics and are conservative in the same time, preserving tooth structure. This feature has made veneers a restoration of choice by many dentists when performing esthetic rehabilitation. However, in these cases, the challenge has always been meeting patients demands and esthetic expectations.1,2,3 Perception of esthetics varies from patient to doctor and miscommunication regarding anticipated result can be frustrating to both ending in a failure.4,5,6 Adequate communication is crucial. Several techniques to overcome such a problem have been suggested in the literature vi z before and after photographs,7 diagnostic wax setups,8,9,10 composite resin mock-up,11,12 computer imaging simulation13 or acrylic resin mock-up. This case report describes a technique were the outcome of the treatment can be communicated to the patient utilizing diagnostic wax setups and bis-acrylic material. Technique: 1. 2. Obtain diagnostic model of the patient and mount models on an articulator (Fig.1). Start and complete diagnostic wax up. Design patients smile based on preliminary information gathered at initial visit (Fig.2). Make a putty index duplicating the wax up: a. b. c. Extend the putty index few teeth distal to teeth intended for restoration. Extend the putty to capture few millimeters of the soft tissue. Make the putty index thick enough to allow for rigidity.

4.

Create a palatal window (Figs. 3 and 4): a. Using #11 blade, cut and remove, from the putty index, the palatal side of the teeth to be restored. Extend the window to the adjacent tooth on each distal side. Do not include the incisal edges in the window. Maintain incisal overlap with the putty index.

b. c.

5.

Trim both distal wing parts of the index so only the imprint of teeth is kept. Remove all soft tissue imprints to minimize interference when seated in the mouth. Trim the imprint of cervical soft tissue of the teeth to be restored so that only about 1mm of cervical soft tissue is kept. Try the index in the patients mouth and verify seating. Line the imprint of teeth with Bis-acrylic material and seat swiftly in the patients mouth (Fig. 5). Using a cotton roll, swipe away the excess material quickly from the palatal side before material starts to harden (Fig. 6).

6.

7. 8. 9.

3.

10. Allow for setting of bis-acrylic and then remove the putty index. 11. Check for adaptation. Remove any over-flashes of material with composite polishing burs. 12. Allow patient to view and try the Mock-up of anticipated final result (Fig.7).

e-Journal of Dentistry Oct - Dec 2011 Vol 1 Issue 4

104

Ahmad Bunashi

www.ejournalofdentistry.com

13. Remove the mock-up by chipping it away with a proper instrument. ( viz;excavators, or explorer) Discussion: A mock-up review of anticipated final restoration is an important tool of communication between the doctor and the patient. This technique allows for a Mock-up to be fabricated with great ease and short clinical time. This technique has several advantages: 1. 2. 3. Does not require sophisticated software or digital imaging. Requires minimum chair time for setting of material and trimming Excellent immediate adaptation to tooth surface without the need for relines or adjustments. Patient can physically experience the anticipated results at hand. Patients remarks are more objective since patients are physically trying a mock-up of the anticipated restorations. Bis-acrylic mock-up can be removed with relative ease with minor risk of locking into teeth embrassures.

Also, it must be kept in mind that this technique is intended when facial veneers are the restoration planned for. Tooth modification is not intended or will be minimal if any. Anticipated restoration is bonded over underlying unmodified tooth structure. The discussed mock-up technique will not serve its purpose when correction of rotated teeth, mal-angled teeth or when considerable amount of tooth structure removal is needed. In such situation, the mock-up created using this technique may not convey an accurate representation of the anticipated restoration. In such cases, tooth modification is completed and full coverage provisionals are more appropriate.

4. 5.

6.

The Bis-acrylate material has a great advantage over polymethy methacrylate (PMMC), a commonly used provisional restoration, because it sets initially in rubbery stage which allows ease of manipulation and less risk of locking into teeth embrasures.14,15 It is very brittle15 and can be easily chipped off the teeth with an excavator or any adequate instrument. It is also the experience of the author that this mock-up can be left clipped on patients teeth for a day. This allows patients to try them among friends and family making the trial experience more realistic and their feed back more objective. It is not recommended to keep them for more than a day due to possible hygiene problems. Disadvantages: One great shortcoming of this technique, it is only good for one time trial. Bis-acrylic brittleness will not allow the created mock-up to be removed and re-inserted again. Attempting to remove the mock-up will most likely cause it to break. Relative high cost of material is another disadvantage. Bis-acrylate material is more expensive in comparison to PMMC.

105

Easy Esthetic Mock-up

www.ejournalofdentistry.com

Conclusion: A method to communicate the anticipated esthetic result to a patient is very important. Several techiques have been discussed in the literature. The technique described in this article provides a method to communicate those anticipated results to patients with ease at the chair-side utilizing bisacrylate material.
REFERENCES 1. Bush JB. Communication and patient education. Dent Assist 1968; 37(2):1921. 2. Christensen GJ. Informing patients about treatment alternatives. JADA 1999;130:730-2. 3. Goldstein RE, Lancaster JS. Survey of patient attitudes toward current esthetic procedures.J Prosthet Dent 1984;52:775-80. 4. Fishman SR, Ortiz E Jr. Effective case presentation. Dent Clin North Am 1977; 21:539-48 5. Manji I. Getting Patient To Say Yes: Effective Case Presentations. J Can Dent Assoc 1992;58(8):619-20. 6. Le vin RP. Case accept ance: 20 pitfalls. Compend Contin Educ Dent 2002;23(8):690-2. 7. Weisman G. Before and after: a step beyond with cosmetic imaging. Dent Prod Rep1996:10:99-102. 8. Rudd KD. Making diagnoatic casts is not a waste of time. J Prosthet Dent 1968;20(2):98-100. 9. Johansen R, Dennis Y, Mullick S. Preview of appearance before extensive bonding. Gen Dent 1989;37(1):58-9. 10. Magne P, Magne M, Belser U. The diagnostic template: a key element to the comprehensive esthetic treatment concept. lnt J Periodontics Restorative Dent 1996;16:560-9. 11. Morley J. The role of cosmetic dentistry in restoring a youthful appearance. JADA 1999;130:1166-72. 12. Behle C. Placement of direct composite veneers utilizing a silicone buildup guide and intraoral mock-up. Pract periodontics Aesthet Dent 2000;12:259-66. 13. Papasotiriou OS, Nathanson D, Goldstein RE. Computer imaging versus conventional esthetic consultation: a prospective clinical study. J Esthet Dent 2000;12(2);72-7. 14. Lui JL, Setcos JC, Phillips RW. Temporary Restorations: A Review. Oper Dent 1986;11, 103-110. 15. Christensen GJ. The fastest and best provisional restorations. J Am Dent Assoc 2003;134(5);637-9. 16. Elledge DA, Hart JK, Schorr BL. A provisional restoration technique for laminate veneer preparations. J prosth Dent 1989;62(2);139-42. 17. Sheets CG, Ono Y, Taniguchi T. Esthetic Provisional Restorations for Procelain Veneers Preparations. J Esth Dent 1993;5(5);215-20. 18. Campagni WV, Caponigro CV. Provisional Restorations. CDA J. 1988 Apr;16(4):16-21. 19. Rouse JS. Facial shell temporary veneers: reducing chances for misunderstanding. J Prosthet Dent. 1996 Dec;76(6):641-3.

Source of Support : Nil, Conflict of Interest : Nil

e-Journal of Dentistry Oct - Dec 2011 Vol 1 Issue 4

106

Copyright of E-Journal of Dentistry is the property of E-Journal of Dentistry and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.