Full upper arch composite rehab 8 years later

Posted on January 30 2018

Introduction:

So far this additive composite rehab is working well. Had one recent glitch which was easily correctable.

 

October 2009

Patient's occlusion post invisilign.

October 2009

Appearance of teeth slightly apart.

October 2009

Upper arch

October 2009

Lower arch

October 2009

Patient's vertical appears collapsed.

Wax up

Upper anteriors. #'s 5 thru 12.

Wax up

Right side view of wax up. Will open patient's vertical 3 mm at the bicuspid level. I had patient count 1 to 10 very rapidly while watching the teeth. By observing the distance between the teeth during the counting sequence, it was obvious that 3 mm's would not impinge on the freeway space.

Wax up

Clear Bite registration material syringed over the wax up to make a "Trial Smile" matrix.

Trial Smile

Trial Smile with ExactaTemp using the bite registration. Pt. gave go ahead to proceed with the composite rehab.

Establishing new vertical

Made a lower suck down appliance to establish the new vertical.

Cut back Greater Curve "Wide".

Began with Tooth #8. Cut back Greater Curve "Wide". Tooth isolation extends well into the interproximal and across the labial border. Peripheral isolation critical to preventing marginal staining.

Composite application

Sequence: 1) Preparation: Etch and dry enamel surfaces, Place bonding agent on exposed dentin surfaces. 2) Composite application: Unfilled resin painted over all surfaces followed by a thin layer of flowable composite painted onto the unfilled resin. This makes the flowable even more flowable. Packable composite then Snow Plowed into the flowable. Packable composite purposely over built. Tooth ready for shaping.

Set up for tooth #9

Mesial contact window evident. New vertical was established with the palatal of #8. Suck down vertical appliance no longer needed.

Set up for tooth #6.

 

#'s 5 through 11 completed.

 

Day 1 wrap up

Called it a day. Sent pt. home. I etched, dried and placed temporary composites on the occlusals of the posteriors. Quick to do. Provided maintenance of the new vertical and chewing function.

Set up for #13

Contacts already established so no contact windows needed to be made.

Ready for shaping

 

Upper composite rebab completed

 

Right view

 

Left view

 

Occlusal view

 

Happy patient

At recall tells me his ability to chew has greatly improved with the vertical opening. He has been very compliant with his night appliance.

April 2013

3.5 Years later

April 2013

Occlusal view

November 2017

Patient fractured composite on #7 when he accidentally bit on a fork

November 2017

#7 restored in same manner as described above

November 2017

Occlusal view of upper composite rebab 8 years later

Conclusion:

Do your own wax up. It prepares you better when executing the case. Provides you a better understanding and feel for your intended look and function.

5 comments

  • Vance Wascom dds: February 02, 2018

    Why did you not consider lower arch

  • Dennis: February 02, 2018

    Making veneers and onlays indirectly on a polyvinyl model and bringing them to the mouth makes sense since no preps of the teeth were needed. It would save chair time. The upside to making the restorations directly is more control as you go and better protection from moisture contamination around the margins. However, now that the “U band” is available, it will be easier to place an indirect within the confines of the matrix for the anterior teeth.

  • Nathan Mayo DDS: February 02, 2018

    I have always been amazed at what can be done with modern day composites, and you just proved it again. Nice work!

  • Dennis Nordlund: February 01, 2018

    I really think it’s terrific that you show the 8 year recall on this great case. Would you consider making your veneers and onlays indirectly on your diagnostic model, and then bringing them to the mouth to bond like you might with porcelain? It would seem to me that you would save hours of chairtime, and be able to make the restorations in the lab at a more comfortable and relaxed pace. Sometimes I feel that even though I saved paying a lab bill, that the increased chairtime ends up costing me more than the lab bill might have been.
    I really enjoy seeing your cases! Keep up the nice work!

  • Louis Sterling: February 01, 2018

    Don’t know how much you charged, but considering the time, effort and expertise involved, it could not have been enough.

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