Smile Design Sequence

1. Smile Design Sequence

3. Pre-operative photographs and study models • The doctor took photographs showing the patients' natural smile at rest with relationship of the lips to the incisal edges. Then he took retracted photos showing the pre-op alignment and buccal corridor. Finally, a photo with a stick bite marking the midline in relationship to the inter-pupillary line. Study models were taken with a face-bow transfer to facilitate mounting on a semi-adjustable articulator. This information was sent to Precision Dental Arts with instructions to create a functional cosmetic preview in wax of the patients finished restorations. Figure 2 Figure 3 Figure 4

4. Cosmetic Preview • Following the Cosmetic Preview checklist along with the doctor's written instructions on length and width of the desired restorations, Precision creates a cosmetic preview in wax of the finished case. This is all done on models mounted on a semi adjustable articulator in order to check for anterior guidance and posterior disclusion, as well as any interferences in function.

5. Silicone putty indexes • Using the cosmetic preview, Precision then created a series of silicone matrices. An incisal edge matrix, a labial index, and a fingered labial index, as well as a full silicone impression of the cosmetic preview to use for temporary fabrication. We send these along with a prepped model to show the doctor where reduction is necessary in order to achieve the result of the cosmetic preview.

6. Duplicate model and clear vaccuform stint • We then created a duplicate stone model from the cosmetic preview, and a vaccuform clear stent. This stent can be utilized to create the temporaries or for the doctor to place over the teeth during preparation in order to see where more reduction is necessary. • Now the cosmetic preview, the silicone matrices, prepped model and clear stent are all sent to the doctor for prep design

7. Preparation Appointment • The patient is now able to preview the final outcome in wax and approve it before beginning the clinical procedure. The doctor has all the information at hand in order to produce the desired outcome . It is very important that the doctor check with the matrices and stent provided to insure proper tooth reduction! This provides the ceramist with enough room to create the contours and color necessary for a successful case. This way we begin with the end in mind. At this point the doctor takes an impression and bite registration.

8. Chair Side Temporary • The doctor fills the silicone matrix with a suitable temporary material. The patient closes into the preformed bite to seat the matrix positively. This is removed after the material sets and the excess is trimmed. Proper occlusion is verified and then an impression of the temporaries in place is taken. Photographs of the temps is also taken with information on the new incisal edges in relationships to the lips and smile line. If this is approved by the patient, this becomes the new preview for the ceramist to use in creating the final restorations. All information is sent back to the Precision Dental Arts.

9. Laboratory Verification • PDA receives an impression or a stone model of the approved temporary, an impression of the preps and a bite registration. We then create a new putty index from the incisal edge of the approved temporary model in order to recreate the temporary shapes and forms in the final restoration. At this point any minor changes desired by the patient must be communicated by the doctor to the laboratory.

10. Restoration fabrication • Any frameworks necessary and the layered porcelain buildup are created within the guidelines of the incisal and labial matrices. Natural contours are created in the porcelain, utilizing the contours of the temporary and cosmetic preview in wax as closely as possible. Customized layering and characterization also help achieve the natural, beautiful smile. This smile design sequence can be utilized for any restoration with any type of substructure.