Dr Neil Harris presents a six-unit restorative case designed to restore a patient’s smile in one appointment after years of damage from a historical eating disorder.
Patient presentation
A long-time patient of the practice presented looking to improve the appearance and function of her lower dentition. With a history of bulimia and significant wear of the teeth, she had previously received full upper arch rehabilitation and had an implant-retained prosthesis in place. The lower anterior teeth had since deteriorated and been treated periodically over the years with composite to enhance their aesthetics. The patient was now interested in a more robust solution.
Assessment and planning
A full assessment was conducted of the current dentition and oral hygiene. Radiographically, no issues were detected and the teeth were periodontally sound. Severe signs of wear were identified and the lower anterior teeth appeared short and uneven. Due to the wear, a lack of guidance for the occlusion was also recorded.
Initially, intraoral scans were taken with the 3Shape Trios scanner. A full suite of clinical photographs was also taken and the information was combined to help plan the best shape and size of the lower teeth. The scans were sent for a digitally designed prototype, which mocked up the incisal edge positions of the lower anterior teeth and allowed us to view them on the photographs as a type of smile simulation for the patient to see.
Once the crown designs were approved, a model was 3D printed with the SprintRay Pro 95 so stents could be created with a thermoformer.
Treatment
Pioneering same day dentistry, the 3D printing workflow allowed the delivery of fast and efficient patient care in this case. The stents were used to create prototypes of the final restorations in the mouth. Using these, the lower teeth were prepared accordingly, after removing all the current restorations. The teeth were scanned again with the Trios, and six individual restorations were designed using the Sirona inLab software.
During the same appointment, the final restorations were 3D printed in under 10 minutes on the new SprintRay Midas 3D printer, using the SprintRay Ceramic Crown resin in a B1 shade, and fitted in the mouth. In a singular appointment of approximately four hours in total, the patient was taken from a fairly extreme condition to fully restored. This included just over an hour to design, print and glaze the final crowns.
The candy coating technique was implemented to finish the crowns. This requires a combination of SprintRay crown resins and GC Optiglaze™ to characterise the restorations for a natural-looking aesthetic.
The crowns were then bonded onto the teeth using a combination of ClearFil SE Bond (Kuraray) and Variolink Esthetic (Ivoclar). These were light cured, following the manufacturer’s instructions.
Outcome
The patient was delighted with the outcome, especially considering that the drastic difference that was made to their dentition in just one half-day appointment. Aesthetically, the smile looks fantastic compared to the broken-down teeth at the very beginning. From a functional perspective, guidance was re-established and occlusion improved. The patient has since returned for a six-month follow-up, which revealed restorations that look great and have lasted really well.
Discussion
The key to this case was the technology involved. The equipment really allowed us to deliver better dentistry to the patient, offering a same-day solution that would not have otherwise been possible to this standard. The concept has been made possible previously for individual units, or maybe a quadrant, but to be able to achieve the same for multi-unit smile makeovers is a significant advancement. The SprintRay 3D printers are the best on the market – they are robust and open source for convenience, but provide predictable outcomes for high-quality same-day dentistry.
This is where dentistry is headed now. The described case was the first we completed using this workflow, but it will not be the last. We are already offering same-day crowns and veneers to patients as standard, and have at least one multi-unit case scheduled per week for the coming months. We are able to invite patients in at 9am with broken teeth and low self-esteem, and see them leave by lunchtime with a smile they are proud to show off. It’s highly rewarding work.
For more information on the 3D printing solutions available from SprintRay, please visit https://sprintray.com/en-uk/
