This document summarizes the conservative treatment of a patient with diastemata using veneers and periodontal surgery at Georgia Regents University College of Dental Medicine. Minimal tooth preparation was done and a diagnostic wax-up and mock-up were used to plan the veneers. Periodontal surgery was performed to establish the biologic width. Porcelain veneers were then bonded using a minimal preparation technique and careful cement removal. The final result improved the patient's esthetics and function with conservative treatment.

1. Correcting Esthetic and Functional Issues at Georgia Regents University
College of Dental Medicine: Using Conservative Veneers and Periodontal Surgery
Barry D. Hammond, DMD | Jae Seon Kim, DDS, MSD, FACP | Jimmy Londono, DDS | Marko Tadros, DMD | Aram Torosian, CDT, MDC, AS

2. Dr. Hammond is an associate professor and
director of Dental Continuing Education,
Department of General Dentistry, Georgia
Regents University (GRU) College of Dental
Medicine in Augusta, Georgia.
Dr. Kim is a diplomate, American Board of
Prosthodontics; and an assistant professor,
Department of Oral Rehabilitation, GRU College
of Dental Medicine.
Dr. Londono is an assistant professor,
Department of Oral Rehabilitation, GRU College
of Dental Medicine.
Dr. Tadros is a first-year graduate prosthodontic
resident, GRU College of Dental Medicine.
Mr. Torosian is a master dental ceramist at the
Goldstein Center for Esthetic and Implant Dentistry,
GRU College of Dental Medicine.
Disclosure: The authors did not report any disclosures.

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belong to the authors.
Copyright © 2016, All rights reserved. No part of this slides share may be reproduced,
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electronic or mechanical methods, without the prior written permission of the publisher.

4. Facial analysis. Repose (rest position).
Patient’s chief complaint was, “I want to close those spaces.”

5. The patient had minimal dental restorations and was classified
as a low caries-risk patient with visible diastemata mainly in the
maxillary anterior region.
Maximum intercuspation.

6. A diagnostic wax-up was completed with the aid of Digital
Smile Design to address the esthetic problems previously
described.
Digital esthetic mounting and smile design. Diagnostic wax-up.
Coachman C, Calamita M. Digital Smile Design: a tool for teaching treatment planning and
communication in esthetic dentistry. QDT 2012. Hanover Park (IL): Quintessence Pub.; 2012.

7. A bis-acryl esthetic mock-up based upon the diagnostic waxup
was performed to assess the shape, incisal display, and
gingival outline, and to give the patient an esthetic preview of
the proposed treatment.
Initial intraoral mock-up. Patient in repose with bis-acryl
mock-up.
Patient smiling with bis-acryl mock-up.

8. A full-thickness mucoperiosteal flap was reflected subsequently
and bone was removed to establish the patient’s unique
biologic width.
Flap elevation prior to bone reduction, showing need
for labial osseous reduction.
Osseous crest placed 3 mm from the apical margin of
the proposed porcelain veneer margin.

9. The repositioned free gingival margins will allow for better
gingival symmetry and tooth proportions.
Three months post esthetic crown-lengthening surgery.

10. A second bis-acryl mock-up was used as a guide for the
minimal preparation technique as described by Gürel, and
Magne and Belser.
Second diagnostic mock-up.
Gürel G. Porcelain laminate veneers: minimal tooth preparationby design.
Dent Clin North Am. 2007 Apr;51(2):419-31, ix.
Magne P, Belser U. Bonded porcelain restorations in the anterior dentition: a
biomimetic approach. Hanover Park (IL): Quintessence Pub.; 2002.

11. The incisal edges were reduced by 1.0 mm using a high-speed
round donut-shaped diamond-coated bur. The depth cuts were
connected using a flat-end tapered coarse bur.
Depth guide cuts made through the
mock-up.
Pencil markings indicating the
minimal amount of preparation
needed.

12. A
mosquito
diamond
was
used
to
round
off
sharp
corners
and
line
angles.
Final conservative preparations.

13. Using a silicone matrix fabricated from the definitive wax-up,
a cutback was performed to control thickness of the veneering
ceramic.
Definitive wax design of the final restorations on the
master solid cast.
Labial cutback using silicone matrix as a guide.

14. Using the marked outlines as a guide, final contour adjustments
were made.
Morphological contouring.

15. To achieve lifelike characteristics of the ceramic, subtle external
stains were applied to the surface prior to glazing. A fixation
firing was subsequently carried out to freeze the stains in
place, followed by glaze paste application and hand polishing
with silicone wheels and #3 fine pumice.
Final anterior restorations on solid cast.

16. A non-latex rubber dam was placed using the slit technique
and 000 cords were placed around each preparation to control
sulcular fluids and facilitate cement removal.
Rubber dam in
place using slit
technique.

17. The teeth were etched using 32% phosphoric acid for 15
seconds and rinsed, followed by adhesive application.
Adhesive application.

18. The veneers were gently placed on the teeth and excess
cement carefully removed, then spot photopolymerized using
a 2-mm small light guide for five seconds on the cervical of the
veneers to tack the veneers in place.
Tack photopolymerization of the veneers.

19. Final removal of any residual cement was performed, followed
by application of glycerin gel at the margins to prevent
formation of an oxygen-inhibited layer.
Application of glycerin gel.
Bergmann P, Noack MJ, Roulet JF. Marginal adaptation with glass-ceramic inlays
adhesively luted with glycerine gel. Quintessence Int. 1991 Sep;22(9):739-44.

20. Definitive photopolymerization was performed for 40 seconds
facially and palatally, followed by removal of the retraction
cords and careful removal of any remaining resin cement with
a #12B disposable scalpel.
Definitive photopolymerization of the resin cement.

21. An occlusal guard was fabricated and delivered to the patient at
a subsequent appointment to provide nighttime protection for
the new restorations. The final result met the esthetic and
functional results desired.
Final restorations, two
months postoperative.

22. The final outcome was a result of careful
diagnosis, treatment planning, and delivery
of care in a dedicated environment, and is
representative of the level of care that
students and residents working together are
able to provide through the Goldstein Center
for Esthetic and Implant Dentistry at GRU.

23. _______________________________
The AACD would like to thank the authors of
this SlideShare for their work and dedication
to the education in esthetic dentistry.
_______________________________

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