Advanced Magnification for Improved Quality Control: Balancing the Art, Science, and Business of Dentistry

(Continued)

Case 2

A 15-year-old female patient presented for restoration of the maxillary region (Figure 11). Teeth #7(12) and #10(22) were missing and required orthodontic treatment as well as restoration with cantilevered pontics. The patient desired conservative restoration of the anterior region using porcelain veneers. The cantilevers were scheduled for placement on the lingual aspects of teeth #6(13) and #11(23).

Figure 11. CASE 2. Preoperative facial view of the patient upon presentation. Teeth #7(12) and #10(22) were missing and aesthetic restoration of the entire anterior region was desired.

Restorative Procedure
Bone sounding and bipolar tissue removal (Bident, Philadelphia, PA) were performed to ensure minimal damage to the gingival tissue. Tissue healing and tooth preparations were evaluated under high magnification and care was taken during final polishing to prevent damage to the soft tissues (Figure 12). While the issue of cantilevers for missing teeth has been the subject of literature and beyond the scope of this article, please note the design of the lingual retainer preparation, which was used to provide mechanical and chemical retention (Figure 13).

Figure 12. The veneer preparations were modified with a finishing bur under high magnification, taking care to preserve the soft tissue margins.

Figure 13. Occlusal view of the veneer preparation demonstrates placement of cantilever design for mechanical and chemical retention.

Impressions were obtained using the H&H technique to allow for accurate reproduction of the pre pared structures (Figures 14 and 15). Preoperative photographs and impressions were forwarded to the laboratory to allow development of working models (Figure 16), and the cantilever pontics were fabricated with a gold arm on the lingual aspect of the preparations (Figure 17). Upon return of the definitive restorations, the teeth were cleaned using pumice and water and acid-etched prior to the application of a primer (Panavia, Kuraray, New York, NY). The final insertion of these restorations was performed using a dual-cured resin cement (Panavia F, Kuraray, New York, NY) according to the manufacturer's instructions. The veneers were finished and bite adjusted in excursive movements and the final finish verified with high magnification (Figure 18). The final polishing was performed using a diamond polishing kit (ET, Brasseler USA, Savannah, GA) and rubber discs, points, and cups (One Gloss, Shofu, Menlo Park, CA). The definitive restorations were inserted with great patient satisfaction (Figure 19).

Figure 14. Magnified view of the impression taken using the H&H technique demonstrates marginal detail and accuracy.

Figure 15. The tooth preparations and location of the edentulous spaces were accurately captured and evaluated prior to forwarding the impressions to the laboratory.

Figure 16. Impressions were forwarded with preoperative photographs to allow laboratory fabrication of a preoperative stone model of the patient's existing condition.

Figure 17. The cantilever pontic was fabricated with a gold lingual arm and evaluated under increased magnification to ensure proper fit prior to delivery.

Figure 18. The definitive restoration was seated intraorally and polished using finishing burs (ET, Brasseler USA, Savannah, GA).

Figure 19. Postoperative facial view demonstrates aesthetic integration of the definitive veneers and pontic restorations.

CONCLUSION

Incorporation of increased magnification allows the user improved visualization of the surgical field. Both clinicians and technicians can use this tool to ensure development of aesthetic and functional restorations for any type of treatment indication. Evaluation of the existing structures can be facilitated with ease to allow proper diagnosis and treatment planning. Tooth preparation, impression taking, and maintenance of the gingival architecture can be carefully implemented using this tool to allow accuracy and precision during the clinical protocol. Laboratory fabrication is also facilitated using magnification, as the working models and restorations can be carefully evaluated to determine proper fit prior to intraoral delivery. Use of increased magnification allows the restorative team to clearly communicate any existing structures and details that must be reproduced in the restoration, for consistent and reliable results.

Acknowledgment
The author would like to thank daVinci Studios (Woodland Hills, CA) for fabrication of the restorations depicted herein and Wallach Surgical Devices, Inc. (Orange, CT) for providing the microscopes.

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