Getting a Smile Design RIGHT

This is a little tip for ensuring smile designs go right first time, and it involves an accurate impression of the palate at pre-op impression stage... let me explain.

When we do diagnostic wax ups for crowns or veneers we make 2 matrices to help with the preps, one shows buccal reduction and one show incisal reduction. The key point here is that the incisal reduction matrix often only locates on the palate, especially when posteriors are also being included in the smile design.

After you have prepared the veneers/crowns and we come to make the definitive restorations we use this matrix to build the restorations in to, this ensures we position the incisal edges in exactly the right place. Once again this matrix often locates on the palate only, so if the impressions of the palates from the original diagnostic and the definitive preps don't match then we are not always able to transfer this matrix.... possibilities for errors creep in!

So, although the impression of the teeth and preps is vital, for complete reliability and to reduce the chance of uncertainty, we need an accurate impression of the palate on both the original diagnostic and the final prep impressions.

Should you break the contact points on veneer preparations?

As the demand for minimally invasive dentistry increases and as the demand for great looking teeth increases at a steady rate also, a question we are often asked at the lab is "Should I break the contact points with these preps?"

The answer is YES.

1. When we are trying to realign teeth and need to move mesial or distal line angles
2. When there is a mesial or distal composite filling and the finish line is likely to be in composite
3. When teeth are very crowded and we are unable to get a reasonable thickness to the veneer of around 0.4mm
4. When the veneers are covering vey dark teeth and there is a risk of show through from underneath
   

The answer is NO.

1. No need to do it routinely
2. When small adjutments to shape are required
3. When no adjustment to shape is required and the veneers are for mild-moderate colour purposes
4. On spaced teeth

The simplest way to ascertain this is to do a diagnostic wax up and have the laboratory do an 'ideal preparation' model - this should take in to account the existing teeth position and the ideal position (from the waxups). This prep model should be a 'how to ge there' kind of model, with realistic proposals for preps.

So what do you think?

When would YOU break the contact points?

Speak soon,

Mark

Cosmetic Dental Laboratory Smile Designs

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