Figure 1: Her pre-restorative condition included diastemata, prominent labial frenum attachment, enamel fluorosis, caries, a missing tooth at site #30 and a high smile line. A comprehensive treatment plan was developed for a full-mouth makeover, which included caries control, labial frenectomy, Invisalign^® treatment (Align Technology, Inc.; Tempe, Ariz.) to move the teeth into a more favorable restorative position, implant placement at site #30, maxillary anterior gingivectomies, BioTemps Provisionals, and the delivery of BruxZir Esthetic crowns on teeth #2–15 and #18–30.

Figures 2a, 2b: After completion of her caries control, labial frenectomy and orthodontic treatment, digital impressions were taken and sent to the laboratory. BioTemps Provisionals, shown here on a 3D-printed model, were fabricated by the lab.

Figure 4: This thermoformed stent has many uses, and in this case, I also utilized it as a reduction guide and a gingival-contouring guide. Knowing that the definitive restorative material would be BruxZir Esthetic, preparations were created with chamfer margins and room for 1.25 mm of material thickness, with transitional edges, angles, and corners rounded off. Then, using a Waterlase tissue laser (BIOLASE, Inc; Foothill Ranch, Calif.), I followed the contours of the stent to perform a gingivectomy.

Figure 5: One issue dental technicians often experience is when tooth preparations do not meet the material-specific reduction requirements. This forces a choice between creating restorations with minimal material thickness and reduced strength, or requesting that the dentist reduce more after the restorations have been returned to the practice, which may compromise the fit. It is vital that clinicians are familiar with and follow the specific preparation requirements of the material they plan on utilizing.

Figure 6: Then, I used the stent to seat the BioTemps Provisionals to ensure the correct orientation.

Figure 7: Approximately one month later, after the soft tissue had healed, the patient returned for an impression appointment for the final restorations. In addition to taking impressions of the preparations, impressions were taken of the BioTemps in place to communicate minor adjustments back to the laboratory.

Figure 8: The definitive restorations were all single-unit crowns made from BruxZir Esthetic Zirconia. For this case I selected BruxZir Esthetic because it provides the desired strength, natural-looking translucency, and perhaps most importantly, a soft-tissue response that’s comparable to that of natural teeth.

Figures 9a, 9b: The treatment resulted in a transformative smile makeover for the patient. Upon completion of the treatment, she remarked: “Having a new smile has been rewarding in ways that I couldn’t have imagined. While I’ve always felt confident, my new smile is exciting and gives me opportunities to explore something new.”