Dental Asia March/April 2019

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Behind the Scenes REPLACEMENT OF EXISTING PORCELAIN VENEERS TO ALL-CERAMIC VENEERS WITH DIGITAL WORKFLOW By Dr. Luke Cronin A case presentation featuring 3Shape TRIOS, 3Shape Smile Design and 3Shape Dental Designer in replacing porcelain veneers with all-ceramic veneers. Case information Patient is a 26-year-old female that presented with six existing, three-year old porcelain veneers and was unhappy with the appearance. The existing veneers were too labially placed with a significant midline cant and the canines were flared giving the overall appearance of teeth that were too large. Treatment plan In consultation with the patient, the decision was made to replace the existing six porcelain veneers with 10 all ceramic veneers. Addition of veneers for the first premolars and first molars (second premolars extracted) both broadens the smile and allows a more harmonious appearance, particularly when viewed at the social angles (45 degrees from the facial aspect). plan to address patient’s concerns. In this case the following photos were taken: facial smiling, facial retracted, facial repose, retracted occlusal, 12 o’clock and retracted lateral and facial views (Figs. 1-8). Fig. 1 As the treatment required was reductive, the final position of the veneers has to be more palatal and a three-stage smile design process was necessary. Initially, a two-dimensional design was created using 3Shape Smile Design to determine the new outlines of the veneers from the facial view. Secondly, the twodimensional design was overlaid on the 3Shape TRIOS 3 .stl file using 3Shape Realview to create an additive motivational mockup for the patient to sign off on. Finally, an ideal mock-up was created using 3Shape Dental Designer for use as a preparation guide and temporary veneers. Photographic Protocol Precise digital photography is necessary to fully understand the current situation and in turn, create an appropriate treatment Fig. 2 Fig. 3 62 DENTAL ASIA MARCH / APRIL 2019
Behind the Scenes Fig. 4 3Shape Smile Design 3Shape Smile Design was used as a communication tool for both the patient and laboratory (Race Dental). 3Shape Smile Design utilises live mock-up capabilities in two dimensions to illustrate the appearance of the teeth from the facial aspect. This is powerful for the patient as it is a simple tool for visualisation of a possible final outcome. The 3Shape Smile Design also doubles as a communication tool for the laboratory, simplifying the description of the proposed final aesthetics determined with the patient chairside (Figs. 9-12). 3Shape TRIOS 3 scan Following the completion of the two-dimensional smile design, a three-dimension image of the dentition is required to proceed to the three-dimensional smile design components. 3Shape TRIOS 3 scan was used to capture this information (Fig. 13). Fig. 13 Fig. 5 Fig. 6 Fig. 7 Fig. 9 Fig. 10 3Shape RealView smile design 3Shape RealView enables the technician to incorporate the two-dimensional photos, the 3Shape Smile Design and the 3Shape TRIOS scan .stl file in the same software. This simplifies the transfer of the information from two-dimensions to three dimensions and creates both predictability and repeatability within the software platforms. This technology also provides reassurance for the clinician that the final outcome delivered will match exactly what was viewed by the patient. Additive mock-up In this case, we needed to show the patient the three-dimensional result using a bis-acrylic temporary mock-up over the existing unprepared dentition which required the first design to be entirely additive (Fig. 14). Fig. 11 Fig. 8 The above photos illustrate clearly the encroachment on the wet-dry lip line particularly in the central incisors and canines. The facial repose and 12 o’clock views, in particular, clearly highlight the problem. Fig. 12 Fig. 14 When showing the patient an additive mock-up in a reductive case, it is imperative that the patient only views the mock-up from a full facial photo and not in real time, up close, or from other MARCH / APRIL 2019 DENTAL ASIA 63
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CONTENTS MARCH / APRIL 2019 18 24 2
Page 6:
First Words The New Age of Digitali
Page 10 and 11:
Dental Updates New VOCO Prophylaxis
Page 12: Dental Updates AACD Welcomes 2019 C
Page 15 and 16: Periodontal Disease Bacteria Linked
Page 18 and 19: Dental Updates Henry Schein One Acq
Page 20 and 21: Under the Spotlight 18 DENTAL ASIA
Page 22 and 23: Under the Spotlight It is easy for
Page 24 and 25: Word of Mouth by Dr. Christoper Ho
Page 26 and 27: CELEBRATING DIGITAL TRANSFORMATION
Page 28 and 29: Dental Profile achieve very good re
Page 31 and 32: Dental Profile TAKING DIGITAL IMPRE
Page 33 and 34: Dental Profile The high-precision S
Page 35 and 36: Dental Profile MARCH / APRIL 2019 D
Page 37 and 38: Clinical Feature The importance of
Page 39 and 40: Fig. 8: X-ray after extraction show
Page 42 and 43: Clinical Feature Glass Ionomer Seal
Page 44 and 45: Clinical Feature Fig. 1.1: An erupt
Page 46 and 47: Clinical Feature 7 TH GENERATION AD
Page 48 and 49: Clinical Feature 1. Decay is noted
Page 50 and 51: User Report CENTION N: REDEFINING D
Page 53 and 54: User Report Amalgam GIC Cention N P
Page 56: User Report Fig. 15: Teeth 46 and 4
Page 59 and 60: User Report initial drilling channe
Page 61 and 62: User Report Fig. 16: Postoperative
Page 66 and 67: Behind the Scenes angles due to the
Page 68 and 69: Behind the Scenes and silanated for
Page 70 and 71: Behind the Scenes A JOURNEY THROUGH
Page 72 and 73: Behind the Scenes Fig. 11 Fig. 15 r
Page 74 and 75: Behind the Scenes The overall aesth
Page 77 and 78: In Depth With Fig. 1: Primescan - t
Page 79 and 80: In Depth With The blue light used b
Page 81: In Depth With The first set of data
Page 85 and 86: In Depth With Extending Dental Oper
Page 87 and 88: In Depth With combines the cutting-
Page 89 and 90: Product Highlight BRAVIA ® XL Spec
Page 91 and 92: Product Highlight COLTENE Unveils t
Page 93 and 94: Product Highlight 3Shape launches T
Page 96 and 97: Show Preview 9 th -12 th June 2019
Page 98 and 99: Giving Back to Society February is
Page 102: Advertisers’ Index Advertisers Pa
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Dental Asia March/April 2019

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