Figures 1a, 1b: It was evident that Anthony had lost posterior disclusion and that movement of the mandible in protrusion was damaging the incisal edges. The longer the current situation continued, the greater the risk for full destruction of the teeth. Caries needed to be removed from teeth #8 & #10, and his missing teeth #3 & #13 needed to be replaced with bridges.

Figures 2a, 2b: To reinvigorate Anthony’s smile, we chose a final shade of A2. During a later appointment we applied Opalescence^® Boost in-office bleaching (Ultradent Products, Inc.; South Jordan, Utah) on the lower teeth to achieve congruous shading.

Figures 2a, 2b: To reinvigorate Anthony’s smile, we chose a final shade of A2. During a later appointment we applied Opalescence^® Boost in-office bleaching (Ultradent Products, Inc.; South Jordan, Utah) on the lower teeth to achieve congruous shading.

Figures 3a, 3b: The most urgent treatment goals were to remove the caries, stop the destructive occlusal pattern, restore canine guidance, and start evaluating the occlusal forces and VDO. Success in anterior wear cases depends upon the development of proper anterior guidance to allow for posterior disclusion. I acted quickly to provide Anthony with an interim restoration in one visit. I used the articulated models to wax up the missing structure for teeth #6–9 and then reached for Capture^® clear bite registration material, a clinical essential from the Capture VPS Impression System (Glidewell Direct; Irvine, Calif.). In mere minutes, I created a matrix from the Capture material.

Figures 3a, 3b: The most urgent treatment goals were to remove the caries, stop the destructive occlusal pattern, restore canine guidance, and start evaluating the occlusal forces and VDO. Success in anterior wear cases depends upon the development of proper anterior guidance to allow for posterior disclusion. I acted quickly to provide Anthony with an interim restoration in one visit. I used the articulated models to wax up the missing structure for teeth #6–9 and then reached for Capture^® clear bite registration material, a clinical essential from the Capture VPS Impression System (Glidewell Direct; Irvine, Calif.). In mere minutes, I created a matrix from the Capture material.

Figures 4a, 4b: I applied a Ribbond^® fiber reinforcement ribbon (Ribbond, Inc.; Seattle, Wash.) to the palatal surfaces of teeth #6 & #8 to reinforce the planned 3-unit bridge. Then, I injected Camouflage^® NanoHybrid Composite (Glidewell Direct) through prefabricated holes in the matrix and light-cured for 20 seconds, starting with tooth #9. This interim composite bridge effectively lengthened the worn-out anterior teeth, reestablished canine and protrusive guidance, and reconstructed the incisal edges. Subsequent appointments for Anthony were focused on delivering 3-unit bridges for teeth #2–4 and #12–14, followed by final restorative care in the anterior region of the mouth.

Figures 4a, 4b: I applied a Ribbond^® fiber reinforcement ribbon (Ribbond, Inc.; Seattle, Wash.) to the palatal surfaces of teeth #6 & #8 to reinforce the planned 3-unit bridge. Then, I injected Camouflage^® NanoHybrid Composite (Glidewell Direct) through prefabricated holes in the matrix and light-cured for 20 seconds, starting with tooth #9. This interim composite bridge effectively lengthened the worn-out anterior teeth, reestablished canine and protrusive guidance, and reconstructed the incisal edges. Subsequent appointments for Anthony were focused on delivering 3-unit bridges for teeth #2–4 and #12–14, followed by final restorative care in the anterior region of the mouth.

Figures 5a–5c: After preparing the anterior teeth and taking impressions for the final restorations, it was time to deliver the BioTemps^® Provisionals. To aid in proper orientation of BioTemps Provisionals during reline, I recommend ordering a fast seating matrix from the lab.

Figures 5a–5c: After preparing the anterior teeth and taking impressions for the final restorations, it was time to deliver the BioTemps^® Provisionals. To aid in proper orientation of BioTemps Provisionals during reline, I recommend ordering a fast seating matrix from the lab.

Figures 5a–5c: After preparing the anterior teeth and taking impressions for the final restorations, it was time to deliver the BioTemps^® Provisionals. To aid in proper orientation of BioTemps Provisionals during reline, I recommend ordering a fast seating matrix from the lab.

Figure 6: After two weeks, the 7-unit BioTemps provisional was removed, and the preps were cleaned of temporary cement and pumiced. Next, the final restorations were tried in to evaluate marginal fit, esthetics, occlusion and phonetics. The BruxZir Esthetic restorations reflected the guidelines of the BioTemps Provisionals, so only minimal adjustments were needed at delivery. After trying in the restorations, the intaglio surfaces of the restorations were cleaned with Ivoclean^® (Ivoclar Vivadent, Inc.; Amherst, N.Y.) and blasted with CoJet™ sand, 30-µm silicatized sand, using the CoJet system (3M™ ESPE™; St. Paul, Minn.).

Figures 7a, 7b: For delivery of the final restorations, I chose to seat all the units with Variolink^® Esthetic DC (Ivoclar Vivadent, Inc.), a dual-curing luting composite. I applied pressure and cured the cement for two seconds, which resulted in a gel state that was easy to remove with an explorer. Thread seal tape also served to streamline cleanup, as the tape conveniently isolated the adjacent teeth and those hard-to-reach sites where cement overflow can collect, such as under the pontic or interproximal areas. In the final stages of delivery, I checked occlusion, made some minor adjustments, and smoothed and polished the restorations.

Figures 7a, 7b: For delivery of the final restorations, I chose to seat all the units with Variolink^® Esthetic DC (Ivoclar Vivadent, Inc.), a dual-curing luting composite. I applied pressure and cured the cement for two seconds, which resulted in a gel state that was easy to remove with an explorer. Thread seal tape also served to streamline cleanup, as the tape conveniently isolated the adjacent teeth and those hard-to-reach sites where cement overflow can collect, such as under the pontic or interproximal areas. In the final stages of delivery, I checked occlusion, made some minor adjustments, and smoothed and polished the restorations.

Figures 8a, 8b: The BruxZir Esthetic restorations dramatically renewed Anthony’s smile, from reconstructing healthy function to providing a natural appearance that looked outstanding from every angle. Prescribing the remarkably strong BruxZir Esthetic material for the bridge, crowns and Vivaneer BruxZir Esthetic Veneers enabled seamless results.

Figures 8a, 8b: The BruxZir Esthetic restorations dramatically renewed Anthony’s smile, from reconstructing healthy function to providing a natural appearance that looked outstanding from every angle. Prescribing the remarkably strong BruxZir Esthetic material for the bridge, crowns and Vivaneer BruxZir Esthetic Veneers enabled seamless results.

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After

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