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Unmasking Tooth Transformations

Unmasking Tooth Transformations

This tip demonstrates how the removal of old restorations can unveil less-than-ideal tooth positions and preparations and offers guidance on ensuring a harmonious final result.

Summary

In this video, the focus is on addressing the complexities that arise when dealing with varying tooth preparations and positions, especially when patients have existing dental work such as crowns and veneers. The presenter acknowledges that it can be particularly challenging to determine the actual tooth structure beneath the restorations, which is crucial for understanding the tooth's true position, especially with crowns.

Veneers can offer some clarity regarding tooth position, but even with veneers, there can be challenges. For instance, when veneers wrap around the tooth, it becomes challenging to assess their thickness and the extent of tooth reduction beneath them.

To illustrate these challenges, the video presents a specific case study involving a patient with veneers on teeth eight, nine, and ten. These veneers were relatively thick and extended around the edges of the teeth. The presenter highlights several issues observed in the patient's smile. These issues include problems related to axial inclination (the tilt or angle of the teeth), a noticeable difference in size between contralateral teeth (for example, the difference between one lateral incisor and the other), and concerns about color uniformity. The presenter also points out that the patient's gingival architecture has a flat scallop, particularly between teeth eight and nine, which poses challenges in managing the pink aesthetics (the gum tissue).

Addressing these challenges, the presenter emphasizes the importance of considering both the white aesthetics (the tooth appearance) and the pink aesthetics (the gum and tissue appearance). They discuss reshaping the teeth to improve the gingival scallop, recognizing that they couldn't drastically alter it. By changing the shape of the teeth, the practitioner could make adjustments to the tissue appearance, ensuring that the white and pink aesthetics complement each other.

The video showcases the patient's smile from various angles, including full-face views and retracted views. It's noted that improving the patient's smile isn't just about addressing the smile itself; it's also about ensuring that it harmonizes with their overall facial aesthetics.

The presenter highlights the importance of data collection, including digital and analog face bows, photos, and shade guides. They emphasize the significance of providing the dental lab with a comprehensive understanding of the patient's situation, allowing for precise planning and execution of the restoration.

The video also touches on the differences in enamel thickness and the use of shade guides for teeth with enamel versus those with dentin exposure. In cases where teeth are entirely in enamel, the presenter recommends using a Vita Shade tab rather than a Prep Shade tab to communicate the desired tooth shade to the lab. Moreover, the importance of blending the restoration's shade with the surrounding dentition and opposing arch is emphasized.

The patient's case was treated by eLab, and the speaker discusses the placement of the shade target between the teeth they sought to match, ensuring that the transition was appropriate.

The video shows the final outcome of the restoration, illustrating how the shape and position of the teeth were adjusted to create a more harmonious smile and gum appearance. The presenter mentions the importance of balancing the restoration with both the white and pink aesthetics to achieve a pleasing result.

Conclusion

In conclusion, the video presents a detailed case study demonstrating the intricacies of addressing tooth preparations, aesthetics, and gingival considerations in restorative dentistry. It encourages dental practitioners to embrace challenging cases like these and provides valuable insights into managing complex restorations for optimal results.

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