Case Presentation: Smile Enhancement Using CAD/CAM Technology
Smile Enhancement Using
A little can go a long way when performing a smile enhancement. My patient, a healthy young man, presented with a reverse smile curve that caused a poor esthetic smile and reduced his confidence when socializing (Figure 1). I felt that a number of dental disciplines could be employed to improve his smile. Orthodontic clear aligner therapy was planned to level, align, rotate, and correct a crowded, narrow arch form. Additionally, 3 first molar teeth would be replaced using ATLANTIS abutments and the Astra Tech Implant System EV (Dentsply Sirona Implants). The maxillary centrals were previously treated with endodontic therapy and 2 restorations that were nonesthetic.
My case presentation for his smile enhancement included Invisalign (Align Technology), Zoom Whitening (Philips), and 4 CEREC restorations (Dentsply Sirona) for teeth Nos. 7–10. The treatment would make use of a lab-processed wax-up to improve the morphology and lengths of the 4 maxillary incisors. The case required increasing the incisal lengths and widths to provide a natural smile curve that followed the curve of his lower lip.
The wax-up is key to make my restorations follow the provisional mock-up that is created by transferring the esthetic wax-up to the patient’s existing dentition. This becomes the proposal and basis for the definitive CEREC restorations. The CEREC software includes a feature called Biocopy, which gives us the ability to copy either a wax-up or a mock-up of the provisionals and then design the final restorations to replicate the morphology, optimal tooth positions, and esthetics. I selected a square-square incisal shape, and my lab returned a beautiful, highly esthetic wax-up.
Figure 1—Preop smile
Figure 2—Laboratory wax-up for Nos. 7–10
Figure 3—Provisional restorations for Nos. 7–10
Figure 4—Preparations and margin for Nos. 8 and 9
Figure 5—Grid to aid in design of central incisors
Figure 6—Veneer preparations and margins
Enter CEREC and the Biocopy imaging of these 4 units, which became the blueprint for the design of the final VITA CAD/CAM restorations. The improved natural and esthetic design was scanned into CEREC. The prepared teeth were optically imaged and this Biocopy proposal was merged and used to design and mill the VITA Mark II restorations. These CAD/CAM blocks are made of highly esthetic feldspathic porcelain and can be milled and polished with smooth well-fitting margins.
Figure 7—Incisal design and proposals for Nos. 7 and 10
Figure 8—The enhanced smile
Figure 9—Postop occlusion with 4 incisors and 3 implants restored
Tags: Invisalign G5, Align Technology, Inc., CEREC Omnicam, CEREC Software 4.5, Monobond Plus, Luxatemp Automix Plus Temporary Crown and Bridge Material, Dentsply Sirona, DMG America, ATLANTIS Patient-specific Abutments, Ivoclar Vivadent Inc., ZOOM CHAIRSIDE WHITENING, ASTRA TECH Implant System EV, SpeedCEM Resin Cement, Clear Aligners, Silane Ceramic and Zirconia Repair Kits, CAD|CAM Software, Abutments, Temporary Provisional Materials, Whitening Lights, Philips Oral Healthcare, Cement resin, Implants, Digital Impressions|Scanners