Zachary S. Sisler, DDS
• Predictable long-term success starts with consistent record taking and methodical treatment planning of the entire masticatory system.
• Silicone matrices can be made from the diagnostic wax-up and then transferred intraorally as preparation guides to ensure uniform thickness, helping to prevent under- or over-preparation of the teeth.
• Proper material selection plays an equal part in the decision tree of treatment. Improper selection could result in damaging effects to surrounding teeth, as seen in this case.
• Form follows function: When proper function has been established in harmony with the temporomandibular joints and muscles of mastication, esthetics fall into place naturally and effortlessly.
Zachary S. Sisler, DDS
Private Practice
Shippensburg, Pennsylvania
Figure 1
Fig 1. This patient had been treated with porcelain-fused-to-metal (PFM) crowns on teeth Nos. 8 and 9 more than 30 years ago. Now, just before her 60th birthday, she had significant wear and wanted a new smile that would last for the rest of her life.
Figure 2
Fig 2 through Fig 4. The PFMs on teeth Nos. 8 and 9 had begun to wear down the lower incisors, resulting in a compromised anterior guidance, which, in turn, led to bruxing of the posterior teeth, causing accelerated wear and further breakdown. Re-establishing immediate disclusion of the posterior teeth with a new, customized anterior guidance would enable this patient to regain the lost function and esthetics that deteriorated over time.
Figure 3
Fig 2 through Fig 4. The PFMs on teeth Nos. 8 and 9 had begun to wear down the lower incisors, resulting in a compromised anterior guidance, which, in turn, led to bruxing of the posterior teeth, causing accelerated
Figure 4
Fig 2 through Fig 4. The PFMs on teeth Nos. 8 and 9 had begun to wear down the lower incisors, resulting in a compromised anterior guidance, which, in turn, led to bruxing of the posterior teeth, causing accelerated
Figure 5
Fig 5. Beginning with a complete examination and set of facebow mounted casts in CR, the amount of interocclusal space that would be gained by allowing the condyles to fully seat into CR became clear.
Figure 6
Fig 6. Silicone preparation matrices made from the diagnostic wax-up allowed the clinician to visualize the targeted tooth form in the final restoration.
Figure 7
Fig 7 through Fig 9. With adequate reduction, the laboratory could fabricate beautiful restorations that also provided the patient with a stable occlusion to prevent further breakdown.
Figure 8
Fig 7 through Fig 9. With adequate reduction, the laboratory could fabricate beautiful restorations that also provided the patient with a stable occlusion to prevent further breakdown.
Figure 9
Fig 7 through Fig 9. With adequate reduction, the laboratory could fabricate beautiful restorations that also provided the patient with a stable occlusion to prevent further breakdown.
Figure 10
Fig 10. New occlusal foundation with stable centric stops on all teeth, coinciding with CR.
Figure 11
Fig 11. Because this patient had high esthetic demands, pressed lithium disilicate was utilized with microlayered porcelain on the facial aspect for a natural surface texture.
Figure 12
Fig 12. The final full-face photograph showed a happy patient with her new, confident smile, designed to withstand the test of time.