Oliver trix 2
- 2. 12 Periodontal Plastic Surgery 1-3 4-6 Anterior Alveolar Ridge Augmentation with Delayed Ovate Pontic Development Patient presents with unnatural ceramic restorations displayed upon smiling. (1 - 3) Retracted facial view of preoperative condition reveals bilateral vertical recession on the maxillary left and right centrals and cuspids with Class I horizontal defects in the edentulous regions of 7 the pre-existing lateral incisors. (4 - 6) A diagnostic wax-up is prepared to the ideal shape and contour without connective tissue corrections. This allows the patient to visualize and understand the importance of soft and/or hard tissue augmentation. (7) 584 585
- 3. 12 Periodontal Plastic Surgery 38 39 40 The ceramo-metal bridges were fabricated using a feldspathic porcelain (Initial™, GC America®) Enamel porcelain was applied over the fired dentin. The entire dentin surface was covered and the lateral segmental layering technique. A 360º circumferential ceramic window (Geller with a combination of translucent and opalescent powders designed to simulate shaded technique) was utilized to allow the light to pass through and create a natural aesthetic result. enamel. Although the enamel layer is thin, it will regulate the the brightness of the underlying The metal framework was designed to a labial silicone index that allows the development of colors as they are projected through it. The value dimension is determined by the artificial an ideal ceramic dimension (38) After the framework was vertically reduced and opaqued, enamel layer. (42 - 43) The initial fire of the enamel layer reveals subtle maverick deposits, a feldspathic ceramic material (Initial™, GC America®) was layered using the lateral segmen- these deposits are not discernible in the mouth but are important for harmonization in the oral tal layering technique to form the artificial dentin core. The dentin layer buildup was slightly cavity with the adjacent natural teeth. Note the shrinkage of the first enamel layer. Any correc- overbuilt interproximally and incisally to compensate for shrinkage. (39 - 40) Once the inter- tions are made before the second fire. The average thickness of natural enamel is slightly less nal dentin core was developed and fired the incisal edge is cutback. The body buildup was than 1 mm and the enamel porcelain layer is 0.3 mm. The artificial enamel layer was slightly completed with incisal cutbacks to accomodate the maverick colors. Internal effects within the overbuilt to compensate for shrinkage. (44 - 45) incisal edge were created by applying specific intensive stains. (41) 41 42 43 44 45 594 595
- 4. 12 Periodontal Plastic Surgery 46 47 The restorations are precisely contoured and finished on a Geller soft tissue model. If prop- Completed 3-unit ceramic bridges. The metal substructure adds physical strength, whereas, erly built up, only a minimal amount of contouring should be required. This consideration is the circumferential window of ceramic material enhances the aesthetics. It is important to extremely important because excess grinding can remove essential color. (46 - 47) remember the ceramic window is fragile until bonded. (48 - 49) Prior to adhesive cemen- tation, the internal surface of the silica-based porcelain shoulder was etched for 2 minutes with a hydrofluoric acid, silanated, and air dried. (50 - 51) Laboratory courtesy of Olivier Tric, C.D.T. 48 49 50 51 596 597
- 5. 52 - 54 55 - 56 Retracted facial views reflect the harmonious integration of biomaterial, soft tissue, and tooth structure. There is a balance in color and function between the maxillary and mandibular teeth and perio-aesthetic harmony. The incisal silhouette of this postoperative smile demon- strates natural aesthetics. (52 - 56) 598 599