WHITENING Whitening was carried out prior to the new restorations . It is advised to wait at least 2 weeks before bonding the composite restorations to allow the shade to stabilise and for the enamel structure to return to normal , allowing the bond strength between the enamel and composite to improve . 8
DESIGN STAGE When considering a re-organisation of an occlusion , the first step is to examine the patient ’ s existing occlusion . 9 The patient had a class 1 skeletal base , with a class 1 incisor relationship . There was canine guidance on left lateral excursion and group function on right lateral excursion , with no working side or non-working side interferences .
In order to deprogramme the jaws and find centric relation , a tongue spatula was used as described by Davies . 10 The patient was asked to slide into lateral and protrusive excursions on this , sliding further back each time she did this . She relaxed back into centric relation quite quickly , and the initial contact in centric relation was between the UR6 and LR6 , which was repeated to ensure the same result was found each time .
The next stage is the design stage . The technician mounted study models using a facebow and the centric relation provided and then constructed the wax-up of the upper 3-3 to idealise the occlusion . The lab then constructed a clear silicone stent using Memosil ( Heraeus Kulzer ). ( Figs . 4,5,6,7 )
This can then be used to transfer the design into the mouth , as described by Ammanato et al . 11 This is as an alternative to using putty palatal indices to first build up the palatal surface , then building up the buccal surface by hand . While generally easier to carry out , the downside to the clear silicone stent technique is that only one shade of composite can be used for each restoration . The advantage of this is that it copies the morphology of the wax-up more accurately , rather than trying to recreate the shape manually .
Rather than proceed straight to placing the restorations , an intra-oral ‘ mock-up ’ was carried out . Luxatemp material was placed into the stent , which was then seated in the mouth and cured . This then gave the patient an idea of what the final result will look like . Although this takes an extra appointment and is therefore more time consuming , the patient then has the opportunity to suggest any changes that may be more difficult to make after the definitive restorations have been placed .
PLACEMENT OF COMPOSITES The Optident Dentoprep mini sandblaster was used prior to bonding the composite restorations , as this has been shown to increase the bond strength between enamel and composite resin . 12 , 13 PTFE tape was used in between the teeth to avoid bonding
Fig . 4
Fig . 6
Fig . 7
Fig . 5
THIS PHOTO : Fig . 6 : Diagnostic wax-up , occlusal view ; ABOVE LEFT : Fig . 4 : Completed Denar
Facebow record ; ABOVE RIGHT : Fig . 5 : Diagnostic wax-up , frontal view ; BELOW : Fig . 7 : Clear silicone stent
the restoration to the adjacent teeth . Heated Filtek-supreme composite was then syringed into the Memosil stent , and then fully seated in the mouth . This was lightcured through the translucent Memosil stent , and the matrix was removed . Any excess interproximally was removed using V-saw strips and interproximal strips , then the restorations were polished using Shofu rainbow discs and white stones . The occlusion was then checked and adjusted , ensuring that this correctly matched the prescription from the diagnostic wax-up . ( Figs . 8,9,10 and 11 )
60 Dental Practice Magazine