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A Smile from Within
Justin Chi, DDS, CDT

article by Justin Chi, DDS, CDT

chairside@glidewelldental.com

Today’s patients have expectations that reach beyond traditional preventive and restorative dentistry. Patients come to our offices now with some knowledge of cosmetic dentistry, and they have desires informed by online information, social media and the experiences of friends. Therefore, dentists are often called upon to overhaul a smile and improve upon the esthetics, contours, morphology and proportions of the patient’s natural teeth in the process.

Case Report

This patient came to our office with a dental concern she’s had most of her life — she didn’t like the size, shape or color of her teeth. Upon examination, it was evident that this patient had a very wide smile, characterized by the visibility of her first molars. The preoperative evaluation also showed that her maxillary teeth were a bit short and somewhat uniform in length across the arch — a look which presents as a more aged appearance. The patient reiterated her lifelong desire for a more esthetic smile and a lighter shade. After a thorough evaluation, the patient accepted our recommendation to provide veneers on teeth #4–13.

When it comes to selecting an esthetic material, this is a wonderful time to be practicing dentistry, because we have a variety of excellent choices. Traditionally, we would have to choose between a material with strength or a material with beautiful esthetics. But with its unique combination of proven strength and lifelike vitality, BruxZir® Esthetic Solid Zirconia is a material that enabled me to confidently offer both properties, without compromise.


Recommended Bonding Protocol for BruxZir® Esthetic Veneers

Treating the Intaglio Surface: When we try in restorations, they become contaminated with salivary phosphates that have a very high affinity for zirconia. We must clean these phosphate groups off in order to establish a strong chemical bond between the tooth prep and the restoration. Any of the following three methods can effectively decontaminate the restoration:

  1. Air abrasion with 50-micron aluminum oxide, with 1–2 bars of pressure.
  2. Ivoclean
  3. 1 percent sodium hypochlorite.

MDP Primer: Once the zirconia surfaces are decontaminated, an MDP-containing primer (10-Methacryloyloxydecyl dihydrogen phosphate) such as Monobond Plus (Ivoclar Vivadent) needs to be applied. The MDP monomer chemically adheres to zirconia and, after application, the restoration is ready for cementation.

Total-Etch Protocol: For the tooth preparations, I use a total-etch protocol:

  1. Etch the tooth preparation with 37 percent phosphoric acid for 15–20 seconds on enamel, 5–10 seconds on dentin.
  2. One-minute application of GLUMA® Desensitizer (Heraeus Kulzer, LLC; South Bend, Ind.); then, aspirate or wipe off excess.
  3. Scrub in Kerr OptiBond™ Universal adhesive (Kerr Corporation; Orange, Calif.); then, aspirate excess, air-thin to remove solvents, and light-cure for 10 seconds.
  4. Cement the veneer with NX3 Nexus™ Third Generation light-cure resin cement (Kerr Corporation). I prefer using a light-cure cement versus a dual-cure for veneers because it allows me unlimited working time to position the restorations.

Conclusion

The patient’s reaction in cases like these is tremendously rewarding and satisfying. It’s gratifying that as dentists we’re able to change someone’s life and make a big emotional impact — building their confidence and giving them a smile that they’re proud to show. A smile is the facial expression that’s most recognizable, and it can be spotted from 300 feet away. That means, even at long distances, it’s easy to see the happiness on this person’s face.

Chairside Magazine: Volume 14, Issue 2

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