Dentaltown August 2020 - 18

show your work
case study

proposals, the patient expressed that she was less
concerned by the aesthetics of her diastema. She
declined the proposed design for tooth lengthening
and diastema closure, and approved the proposed
design for two single central veneers. The patient
scheduled a clinical appointment one week later for
tooth preparation and provisionalization.

Fig. 6: 3D-printed model of the proposed digital design.

Preliminary fabrications
Before her first scheduled clinical appointment,
the laboratory used CAD/CAM technology to
design the temporaries and the final restorations in
exact accordance to the patient-approved 3D virtual
diagnostic wax-up of the final case outcome.
A 3D-printed model of the approved smile design
(Figs. 6 and 7) was used to produce an analog silicone
putty reduction matrix chairside (Fig. 8). Although this
currently is the only analog process in an otherwise
digital workflow, I'm confident that future CAD
software developments will address the need for a
digitally driven 3D reduction guide. One solution
would be a virtual 3D-printed reduction guide that
is delivered with the 3D-printed diagnostic wax-up
model. Another solution would be to design the
intraoral scanner software with the ability to compare
the preparation to the virtual diagnostic wax-up and
identify areas that are underprepared.

Fig. 7: Occlusal view of 3D-printed model.

First clinical appointment
The patient's teeth were prepared using the
reduction guide to ensure that tooth reduction
replicated the digital treatment plan (Figs. 9 and
10). The prepared teeth were then scanned using an
intraoral scanner (Fig. 11) and the scans were uploaded
to the laboratory for final design of the provisionals
and final restorations (Fig. 12).
While the patient waited, the laboratory milled
the tooth-colored temporaries from polymethyl
methacrylate (PMMA) on an Ivoclar Vivadent
PrograMill PM7 mill. The PMMA veneers were
delivered and tried in for patient approval. Once the
patient approved the aesthetics and fit chairside, we
recommended the provisionals be worn for at least a
couple of days to test the fit and function before we
move on to milling the final definitive veneers. When
the patient calls approving the fit and function, we
can confidently move forward with milling the final

18

Fig. 8: PVS putty tooth reduction guide created
on the 3D-printed model of the digital design.

Fig. 9: Teeth #8 and 9 prepared for ceramic veneers.

AUGUST 2020 // dentaltown.com

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Dentaltown August 2020

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