Case 51 | The Award 2017 | Egypt
Dr. Moustafa Ahmed Raafat Elnaggar
Maxillary and Mandibular E-max laminate veneers and crowns.
1. Due to heavy smoking for more than 25 years, the patient was suffering from heavy internal discoloration of all maxillary and mandibular anterior teeth and severe labial attrition in the labial surfaces of maxillary right lateral and mandibular two centrals.
2. Attrition of the incisal edges and cusp tips of the maxillary and mandibular anterior teeth.
3. The mandibular left canine was malaligned and needed orthodontic treatment but the patient insisted to keep it without any modification in its position to keep the “Natural Appearance” as she described.
Treatment Plan and Procedures:
1. Endodontic treatment was done to the maxillary right lateral and mandibular centrals followed by insertion of fiber post of Dentsplay® in all three endodonitcally treated teeth.
2. Maxillary and mandibular Impressions were taken using Rubber base impression material and sent to the lab for construction of “wax up”.
3. Impressions was taken to the “wax up” then introduced into the patient mouth after application of temporary crown material “Provitemp®”in the inner surface of the new impressions for fabrication of “mock up”.
4. Patient opinion was taken regarding the shape of the “mock up”, minor adjustments were done then an impression of the “mock up” was taken with rubber base impression material to send them to the lab as a guide for the final shape desired.
5. Reduction and preparation of the maxillary right lateral and mandibular centrals for construction of E-max crowns.
6. Preparation of the maxillary and mandibular anteriors, maxillary premolars and mandibular first premolars were done for construction of E-max Laminate veneers.
7. Impression was taken “2 step technique” using Panasil® “Putty then Light” Addition Silicone Rubber base impression material for both the maxillary and mandibular arches.
8. Stem shade of the teeth was almost A3 so instructions were given to the lab to use Medium Opacity A1 E-max ingots.
9. The lab fabricated wax pattern using CAD-CAM system, mold pouring, wax elimination, pressing the E-max ingots for fabrication of the crowns and veneers.
10. Etching of the inner surface of the veneers and crowns were done using Hydrophloric acid and then Silane coupling agent was applied after washing out the etching agent.
11. Cementation of the Maxillary and mandibular crowns and veneers were done using flowable composite resin after etching of the surface of the teeth using phosphoric acid and applying a bonding agent to them.
Secondary Casts after preparation
CAD-CAM fabricated waxpattern
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