In this series of articles, I'll be going over the treatment process of Nancy. At the time of treatment she was 79 years old, had no chief complaints except for having her two centrals treated. She had previously had her right central treated with a gold restoration almost 60 years ago that now has caries underneath it.
If you look at the image you'll notice she has some malalignment of her centrals; she and I both wanted to keep some of the malalignment and characterization in the final result.
As you can you see, the right central has a lower value and higher chroma than the left central, and the left central has very large class III composites on the mesial and distal across most of the entire tooth. From a treatment planning perspective, I chose to do full crowns on both centrals.
I started her treatment by sending her models off to the lab for a diagnostic wax-up with the instructions to leave the incisal edge position vertically the same as it is now, but to mildly correct the alignment, leaving them to the facial and the distal slightly forward. It's important to point out that if I had chosen to try and perfectly straighten the alignment, it would have been impossible to achieve without performing endodontics. When the wax-up came back, the incisal edge was perfect but I did some readjusting to bring the distals out slightly and added to the facials to prevent the risk of pulpal involvement.
After I made the corrections to the wax-up I made an alginate impression of the wax-up and poured it in stone. On the stone model I pressed 1mm copyplast to create a clear matrix that can be used to produce a mock-up of the new tooth shape in the mouth, the copyplast can also be used as a preparation guide and matrix for the temporary restorations. The first step in Nancy's treatment was to adjust the distals of her centrals to allow the copyplast matrix to seat completely. One of the advantages of using copyplast is you can see where it is binding and make your adjustments accordingly.
After the copyplast seated completely, I etched the teeth to be able to bond to them, then loaded the copyplast matrix with temporary material to create a bonded mock-up. This allowed me to see a preview of what the end result would look like. The beauty of this step is you have the ability to modify the mock-up until you achieve the esthetics that you are aiming for in the end result.
In Part II I'll discuss what happened after the mock-up was approved.