A Systematic Approach to Case Fabrication

Jonathan Brooks, CDT · Technical · Feb 2014

  • Restorative Challenge

    The male patient exhibited severe wear and wanted to improve his smile. Dr. Alan Rosen, Springfield, MO, determined that improving the patient’s smile meant restoring the patient’s lost vertical dimension and crowning teeth #4-12 and #21-29.

  • Step 1

    To show the patient how he would look, a Smile-Vision cosmetic simulation was completed. This serves two purposes:
    1. It allows the patient, dentist and technician to visualize and agree on the proposed outcome.
    2. The technician can use it as a plan for a diagnostic waxup upon which the provisional and final restorations would be based.

  • Step 2

    Upon patient approval of the smile simulation, the models, CR bite registration and facebow were sent to Smile-Vision and mounted on a Stratos articulator. The smile simulation photos and models were measured in order to determine the dimensions of the teeth shown in the simulation. A waxup was then created to copy the esthetic results of the smile simulation and verify function on the articulator.

  • Step 3

    Pressure-molded temporary templates and preparation guides were fabricated, enabling the dentist to adequately prep the teeth and make temporary restorations that follow the esthetic plan of the waxup.

  • Step 4

    Preparation and temporization were accomplished using the prep guide and temporary template. Temporaries that duplicated the cosmetic simulation were made of bis-acryl and inserted with minimal adjustment.

  • Step 5

    The laboratory fabricated the restorations using the inLab system with its inEos X5 scanner and the Biogeneric Copy feature to scan the models of the preps and the approved provisional restorations and to design the restorations to fit within the exact confines of the provisional:

    Upper and lower models of preps with overlays of provisional models.

  • Step 5 continued

    The proposed restorations were evaluated in relation to the outline of the provisional.

  • Step 5 continued

    The restorations prior to milling in the software.

  • Step 5 continued

    The milled e.max restorations compared to the models of the approved provisionals.

  • Step 6

    Fine finishing, crystallization, incisal layering and stain and glaze of the e.max restorations were completed and the final restorations were placed on the model.

  • Step 7

    The dentist bonded the final restorations in the patient’s mouth. Since the treatment plan was followed, there were no surprises at this point. The patient is used to the contours, lengths and feel of the provisionals, all of which are exactly duplicated in the final restorations.