So far this additive composite rehab is working well. Had one recent glitch which was easily correctable.
Patient's occlusion post invisilign.
Appearance of teeth slightly apart.
Patient's vertical appears collapsed.
Upper anteriors. #'s 5 thru 12.
Right side view of wax up. Will open patient's vertical 3 mm at the bicuspid level. I had patient count 1 to 10 very rapidly while watching the teeth. By observing the distance between the teeth during the counting sequence, it was obvious that 3 mm's would not impinge on the freeway space.
Clear Bite registration material syringed over the wax up to make a "Trial Smile" matrix.
Trial Smile with ExactaTemp using the bite registration. Pt. gave go ahead to proceed with the composite rehab.
Establishing new vertical
Made a lower suck down appliance to establish the new vertical.
Cut back Greater Curve "Wide".
Began with Tooth #8. Cut back Greater Curve "Wide". Tooth isolation extends well into the interproximal and across the labial border. Peripheral isolation critical to preventing marginal staining.
Sequence: 1) Preparation: Etch and dry enamel surfaces, Place bonding agent on exposed dentin surfaces. 2) Composite application: Unfilled resin painted over all surfaces followed by a thin layer of flowable composite painted onto the unfilled resin. This makes the flowable even more flowable. Packable composite then Snow Plowed into the flowable. Packable composite purposely over built. Tooth ready for shaping.
Set up for tooth #9
Mesial contact window evident. New vertical was established with the palatal of #8. Suck down vertical appliance no longer needed.
Set up for tooth #6.
#'s 5 through 11 completed.
Day 1 wrap up
Called it a day. Sent pt. home. I etched, dried and placed temporary composites on the occlusals of the posteriors. Quick to do. Provided maintenance of the new vertical and chewing function.
Set up for #13
Contacts already established so no contact windows needed to be made.
Ready for shaping
Upper composite rebab completed
At recall tells me his ability to chew has greatly improved with the vertical opening. He has been very compliant with his night appliance.
3.5 Years later
Patient fractured composite on #7 when he accidentally bit on a fork
#7 restored in same manner as described above
Occlusal view of upper composite rebab 8 years later
Do your own wax up. It prepares you better when executing the case. Provides you a better understanding and feel for your intended look and function.