Earlier this week I posted about my diagnostics for a smile makeover. Careful measurements lead to the creation of an accurate diagnostic wax up.
Diagnostic wax up completed
Now I’ve shown it to the patient and we’ve decided to move forward with the case. Although a good lab will be able to translate the wax up into the final restorations, it’s also important that we translate the wax up into the provisional restorations. I want the patient to wear the temps for a few weeks to evaluate the shape, phonetics, and other potential changes to their esthetics and function.
First, my colleague Dr. Scott Froum performed some esthetic gingival contouring and crown lengthening. Not much was needed as his teeth were already quite long. Scott used the Picasso Lite, which I enjoy having in the office for various small procedures.
Picasso Lite sculpting gingiva
I like when a laser is used as opposed to a scalpel because there will be virtually no bleeding. That makes my life easier if I want to do the preparation and provisionalization in the same visit as the crown lengthening. Also, much less post-operative discomfort.
Anyway, so I’ll have the laboratory fabricate a vaccu-form matrix of the stone model of the wax up. You can also do this yourself if you wish. Just make sure to duplicate the wax up in a stone model. Otherwise you’ll destroy the wax while making the vaccu-form.
Option 1: clear matrix
Alternatively, you can have a lab-processed provisional fabricated. They may use hollowed out denture teeth, acrylic, or composite. Whatever they use it will probably look better that what we can make chairside.
Option 2: lab-processed provisional
The downside to Option 2 is that this can be difficult to insert. You try to seat it after the teeth have been prepared and it doesn’t go down all the way. Ugh. Now we go back and forth adjusting the internal aspect of the provisional and preparing the teeth further. We have no guide as to how far apically the provisional should seat except for looking at the incisal edges and making an judgment call. We also may inadvertently roll the provisional buccally or palatally or to the left or the right. The former may disrupt the envelope of function; the latter may introduce a horizontal cant.
So I prefer the clear matrix because it gives me the greatest assurance that the provisionals will mimic the wax up.
Prepared teeth #6-11
So we prepare the teeth and get our matrix ready. I like to use a bis-acryl provisional material because they’re strong, easy to adjust, and look great. I’ve been using Telio (Ivoclar) because there’s research to show that can last up to a year if need be.
Seating the matrix filled with Telio
Tease it off after it’s fully set, trim excess, polish, etc. The patient can now evaluate esthetics and phonetics for a few weeks. I can add with more Telio or flowable composite very easily if required. Once the tissue is healed and the patient is happy with the look, shape and feel of the provisionals, I can impression with confidence.
Ready for a trial run...