This guide is written with the belief that any dentist, whatever their level of experience, can take on and complete a smile makeover when working closely with an experienced cosmetic laboratory. However, as a laboratory that believes strongly in further education, we actively encourage that at least some CPD hours are spent on cosmetic courses.
The guide follows a real case undertaken in the laboratory using e.max pressed ceramic veneers and crowns. However the principles apply to any ceramic systems. Please note, if distance is a problem, the laboratory visits 1 and 2 can easily be done by yourselves in your surgery, and any photographs can be emailed. However, in terms of building patient confidence and saving valuable surgery time, the laboratory visits are an invaluable part of our service.
Surgery Visit 1: Impressions for Study Models
We cannot emphasise the importance of the first stage enough. Everything will be compromised if we don’t have accuracy here. Please take upper and lower silicone impressions using a one stage technique, in good quality stock trays with tray adhesive. The wash must be run all the way around the arch. Please check the finished impression very carefully. We will have to ask for new impressions if there is distortion.
Laboratory Visit 1: To View the Diagnostic Wax-Up
This patient required considerable planning as gingival trimming was needed.
Please ask your patient to make an appointment directly with us. Generally this can be made 4 days from receipt of impressions. At this appointment, we will take preliminary photographs, which are printed immediately and used to help in the consultation process.
We will show and discuss the study model and then show the proposed smile design diagnostic wax-up. Generally, after meeting the patient and discussing their requirements, we often find some alteration to the wax-up is required. Changes to the wax-up are made with the patient present and are considered complete when we and the patient are both satisfied. The preparation guide, preparation stents and temporary splints are all now completed and returned to the surgery.
Surgery Visit 2: Case Acceptance
By this stage, the patient will know that they are in professional hands. They will have viewed and been pleased with their proposed new smile. They will know that the surgery and laboratory work as a team with a clear plan to produce the smile that they have always wanted. They will have seen many ‘before and after’ photographs and had plenty of opportunity to make clear their individual requirements. This greatly improves the likely outcome of case acceptance, and you should only need a short surgery visit to finalise the details of the treatment. If part of the treatment plan is to bleach, we recommend that you get your patient started immediately. Good bleaching before preparation can help the base colour of the preparation, and therefore the final colour of the restoration, particularly when thin veneers are involved.
Surgery Visit 3: Preparation, Impressions and Temporaries
We need you to match the preparation guide and try to give you realistic guidance. The closer it is followed, the better the final result. There may be some clinical considerations we are unaware of, which compromise the preparations. In this case, use the principle of being as close as possible to the guide. Aesthetics may be compromised slightly, but generally we should still be able to achieve stunning results. If you use a camera, some emailed photographs of the preparations and a stump shade would be very useful.
The impression should be taken in a full arch, quality stock tray, with the wash run around the whole of the arch and tray adhesive used. The stents prepared earlier from the wax-up will be used to create the final restoration, and must transfer perfectly from one model to the next. Hence, the importance of accurate impressions at every stage.
Finally we need you to make very accurate temporaries. For this we provide a small silicone stent. We find this produces considerably more accurate temporaries than the clear temporary stents sometimes used.
At this appointment, it is important for us to view the temporaries. Small adjustments may need to be made to the diagnostic wax-up – are the temporaries accurate? Do they look correct? Are there some inaccuracies? Do we need to compensate? Obviously, the more accurate the temporaries, the more successful this process. Any final adjustments are made to the diagnostic wax-up.
The veneers are waxed up to stents taken from the diagnostic wax-up, and pressed in e.max pressed ceramic. New stents are prepared and the final e.max restorations are waxed to this and pressed. The wax-up veneers are pressed in e.max, they will be cut off the sprues, trimmed, glazed and polished. Final colour for the restorations is taken at this point, and reference photographs of the temporaries are taken.
Surgery Visit 4: The Fit
This is where all the careful planning pays off. There are no doubts that the case will look good now all the major decisions have already been made and checked. The care and precision taken by us in the final construction of the e.max veneers and crowns will ensure a superb marginal integrity, beautiful contouring to the gingiva, smooth cleansable contacts and a smooth tooth like feeling for the patient’s tongue. It is only left for you to cement and congratulate yourself on a great result.