ANOTHER LOOK AT ‘DENTAL ECONOMICS’
8. The impression was poured up in stone,
and the sulcular tissue was then trimmed
away from the stone model for better ac-
cess with the 3-D scanning acquisition unit
(CEREC Bluecam, Dentsply Sirona).
9. A full-arch digital scan was done. The digital designing of the veneer was assisted by
virtually copying the well-proportioned
contralateral second bicuspid and creating
a “mirror image” of it for the proposal of
the new restoration. This is often the best
we can do to replicate what nature has
already designed (figure 12).
10. The restoration was then milled out with
Dentsply Sirona’s InLab MC XL milling
unit, fit to the model, and polished with
finishing discs and a DiaLite wheel
11. The veneer was then stained, glazed, and
fired in an in-office Programat ceramic
furnace (Ivoclar Vivadent) according to
recommended guidelines for e.max.
12. The restoration was then tried in the
mouth to assess fit and color.
13. Satisfied with the color and fit, we cleaned
the veneer and prepared it for bonding
14. An Isolite was placed for intraoral moisture management, and a new retraction
cord, size one, was placed to protect the
sulcular tissue. The area of the tooth to
receive the bonded restoration was re-abraded with 50-micron aluminum oxide,
etched with blue phosphoric acid for 30
seconds, rinsed, and dried. Two metal
Tofflemire bands were placed interproxi-
mally to prevent undesired adhesive or
cement from entering the contact area.
15. Pic-n-Stic (Pulpdent) was used to hold the
prepared veneer, and clear Multilink Au-
tomix resin cement (Ivoclar Vivadent) was
used, along with its companion bonding
system, to lute the restoration to the tooth.
16. The retraction cord was removed along
with any excess cement. Once cured, the
margins of the restoration were again
cleaned using a Cavitron (Dentsply Sirona)
to ensure no unseen residual cement was
left. Occlusion was assessed to ensure
there were no working or nonworking
interferences with the restoration in function, which will improve longevity.
The patient was seen for follow-up at one
week. Photos were taken again as a record
at two years posttreatment. At two years, the
tissue had remained healthy and the visual
harmony of the restored tooth continued to
be a pleasing enhancement from the
pretreatment condition ( figures 14–16).
Not only can these types of procedures prove
rewarding for the clinician, but in their tooth-sparing designs they can have immense “den-
tal economic” value for the patient.
This is an amazing time in dentistry! Avail-
able to us today are technologies, materials,
and concepts that allow us as clinicians to
be more conservative, efficient, and predictable in our approach, and at the same time
achieve lasting, favorable results—all while
being less invasive of tooth structure. This is
a time when mastering the concept and practice of “dental economics” may be more within
our grasp than ever.
1. 1828 Noah Webster Dictionary of the English
Language. Published by Packard Technologies;
2011. Sourced through Librainia.com. http://www.
2. Responsible esthetics. American Academy of
Cosmetic Dentistry website. http://
responsible-esthetics/. Accessed May 2, 2017.
DDS, graduated with honors
from the University of the Pacific
Aurthur A. Dugoni School of
Dentistry in 2007. He currently
practices in Hamilton, New
Zealand. He can be contacted at
Figure 16: Posttreatment of No. 4, smile view
Figure 15: Two years posttreatment
Figure 14: Pretreatment, magnified right
e.max porcelain etch, 20 seconds
Figure 12: 3-D digital design