Dental Asia March/April 2019

Behind the Scenes
Fig. 11
Fig. 15
region and revealed that the patient was
completely normal. The final prosthesis
was then decided, which comprised of
porcelain fused to metal (PFM) fixed
prosthesis replacing tooth nos. 14-16
region which has less clearance at the
connector region with less pontic height.
Therefore, zirconia copings layered with
ceramic was selected for the remaining
dentition. Tooth preparation and tissue
management was done using a single
cord (Figs. 18-19) followed by impression
taking with polyvinyl siloxane (PVS heavy
and light body). New Provisionals were
fabricated on the prepared teeth, using
the previously made mock up.
Fig. 12
Fig. 16
Fig. 18
Fig. 13
Fig. 14
Phase 3
Kois Deprogrammer was fabricated and
the patient was instructed to wear it full
time for over a week (Fig. 15). The patient
was then scheduled for an equilibration of
the entire dentition. The anterior button
of the deprogrammer was trimmed till 1 st
posterior teeth came in contact and with
sequential use of 200 micron, 100 micron
& 40 micron Bausch paper. The dentition
was made to have simultaneous, uniform
and equal intensity contact points on both
sides (Figs. 16-17).
Fig. 17
A shim stock was used to confirm that
every tooth posterior to the canine had
a positive contact which confirms the
establishment of good occlusion in static
centric relation (CR) position. Pathway
adjustments were done on the mock-ups
with the patient in upright position using
a horseshoe-shaped 200-micron paper
while asking the patient to simulate her
chewing movements. All lateral marking
interferences were removed. Load test
of TMJ was done to ensure there was no
pain or discomfort on both the joints.
Few changes in anterior anatomy were
noted especially with regards to width and
height ratio which will be corrected in the
final prosthesis.
Phase 4
After three weeks, the patient was called
for review and investigation related to
any kind of pain or discomfort in the TMJ
Fig. 19
The objective is to rehabilitate by restoring
aesthetic and functional harmony to
achieve natural looking restorations. This
could only be achieved through proper
laboratory communication, ensuring your
ceramist is completely briefed and making
sure you have left no stones unturned!
Thus, shade matching and all other
detailing was communicated with my
ceramist to ensure accurate and precise
layering of ceramics. The models were
mounted on the articulator for proper
occlusion assessment; the maxillary
arch was first completed followed by the
mandibular arch (Figs. 20-21).
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DENTAL ASIA MARCH / APRIL 2019