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                                                                                           clinical section 07
          DENTAL TECHNOLOGY, OCTOBER-DECEMBER 2017





                                                                                                 Mock-up according to the SKYN concept
                                                                                                 using a light-curing nanohybrid composite
                                                                                                 (IPS Empress® Direct)
                                                                                                 Intraoral digital data scan of the mock-up
                                                                                                 Preparation of the teeth with the help of
                                                                                                 the mock-up
                                                                                                 Digital impression of the preparation using
                                                                                                  an optical camera
                                                                                                 Fabrication of the temporaries
                                                                                                 Machining  of  the  glass-ceramic  veneers
                                                                                                 (IPS Empress CAD)
                                                                                                 Incorporation of the veneers
          FIG 5: The mock-up is placed in the  FIG 6: Completed mock-up. Photos and videos are used to assess it.
          mouth. The surfaces are being                                                        FABRICATING THE WAX-UP
          reworked slightly.
                                                                                               The aim of the ceramic veneers was to give
                                                                                                more volume to the teeth. The teeth should
                                                                                                appear  stronger  and  longer.  Adjusting  the
                                                                                                dental proportions was requisite to creating
                                                                                                a  harmonious  appearance  between  the
                                                                                                teeth and the smile on the patient’s face. To
                                                                                                create the wax-up, we used the SKYN mod-
                                                                                                els (“Anterior Model Set” by Dr Jan Hajtó)
                                                                                                as reference (Figure 2). This is a reproduc-
                                                                                                tion of natural teeth. Upon request by the
                                                                                                patient, tooth selection was performed with
                                                                                                the help of both the DSD program (Digital
                                                                                                Smile  Design)  and  the  VisagiSMile  design
          FIGS 7a and 7b: The surfaces of the mock-up are being reworked slightly.             and visualization software.

                                                                                                TRANSFER TO THE MOCK-UP
                                                                                                We  created  a  silicone  key  of  the  vestibular
                                                                                                surfaces  with  the  help  of  the  wax-up  and
                                                                                                applied  a  thin  layer  of  composite  material
                                                                                                into  the  key  using  a  spatula  (IPS  Empress
                                                                                                Direct)  (Figure  3).  Once  light  cured
                                                                                                (Bluephase®  with  Polywave®  LED),  the
                                                                                                resulting composite veneers for teeth 15 to
          FIG 8: Targeted preparation of the teeth with the mock-up in place  FIG 9: Close-up of the prepared anterior teeth
                                                                                               25 were placed on the model and stabilized
                                                                                                with wax (Figure 4). Once the wax-up was
                                                                                                finalized, it was duplicated and cast in stone.
                                                                                                  We created a silicone key from this model
                                                                                                to assist the dentist in the preparation of the
                                                                                                teeth. The silicone key was created in two
                                                                                                steps using two different silicone materials,
                                                                                                one  with  a  high  hardness  (Silico  Dur,
                                                                                                Cendres+Métaux)  and  the  other  with  a
          FIG 10: The CAD data of the digital impressions of the prepared teeth and the mock-up are superimposed.
                                                                                                low hardness (3M ESPE Express). The sili-
                                                                                                cone key served to create the mock-up and
          CLINICAL CASE                                                  the temporaries.

          Preoperative situation                                         TOOTH PREPARATION AND DATA TRANSFER TO THE LAB
                                                                         The mock-up was inserted with the help of the silicone key and the sur-
          The patient visited the practice with a request that mainly concerned  face  texture  was  reworked  using  a  polishing  system  (Astropol®)
          esthetic criteria. She felt that her anterior restorations looked too yel-  (Figure 5). The esthetic effect was validated with photographs and
          lowish and their shape did not fit in. The restorations had been in her  videos. The patient could also inspect the pictures (Figures 6 and 7).
          mouth for several years.                                       Then, the teeth were prepared using a ball-shaped bur whilst the mock-
            They should now be replaced.                                 up was in place (Galip Gurel 2003) (Figure 8). This procedure meets
            First, a series of digital pictures was taken to examine the situation  the requirements of minimally invasive dentistry. An impression of the
          more closely. The patient had a high smile line. However, the fact that  prepared teeth (Figure 9) was taken using an intraoral scanner and
          her gums were visible when she smiled and her upper lip was asymmet-  the temporaries were fabricated with the help of the silicone key.
          rical did not bother her (Figures 1a and b).                     At this point, the dentist is required to take two optical impressions:
            The periodontal apparatus was healthy. The soft tissues did not show  first, an impression of the prepared teeth and, second, an impression of
          any signs of abnormalities either.                             the  temporaries  in  the  mouth.  In  addition,  a  conventional  silicone
                                                                         impression of the prepared teeth is taken. The dental technician will use
          TREATMENT PLANNING                                             this impression to produce a physical model to check the fit and contact
          We recommended the patient to have the anterior region restored with  points of the milled ceramic veneers.
          veneers stretching from teeth 15 to 25 and advised her to have the pre-
          molars included in the restoration to achieve a harmonious appearance.  CREATING THE FINAL RESTORATION
          The patient agreed with our proposal. We drew up the following treat-  For  the  CAD  construction,  the  two  data  sets  (temporaries,  prepared
          ment plan:                                                     teeth) were superimposed in the software (Figure 10). Subsequently,
                                                                         the shape of the temporaries was matched to the preparation margins.
           Wax-up using composite veneers to reproduce the natural shape and  Each component was examined (preparation margin, thickness, contact
           texture of the teeth                                          points, etc.) separately before the data was transmitted to the milling
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