I am so glad I caught this. I almost made a critical mistake with the provisional restorations for a case I completed earlier this year.
The upper provisional was completed, I thought it looked excellent and went to take a few pictures of it before seating and right there through the camera viewfinder I saw it.
Can you see what is wrong with this provisional?
I left the gingival embrasure between the central incisors closed!
This could have blunted the papilla and left a black triangle at insert (along with an unhappy patient).
Now, as we know from Dr. Dennis Tarnow if the contact point of the restorations is 5.0 mm or less from the interdental peak of bone the papilla will reform.
That is great long term but the patient would not be happy short term. Therefore, I recommend in my trainings to design and contour the gingival embrasures of the provisional to provide space for the papilla.
Here is ideal papilla contour after the removal of long-term provisional restorations. The cement you see on the preparations is Durelon. I use this for long-term provisional restorations but it adheres to tooth structure a little and I remove it with an ultrasonic scaler.
Several different instruments can be used to create ideal gingival embrasure form with your provisional restorations. I like the Vision Flex discs from Brasseler and/or a 7901 carbide to carve the ideal embrasure form.
These ultrathin discs are excellent to define precise embrasure form.
I recommend you instruct your dental assistants to be careful how they handle them for cleaning and sterilization because they are expensive and if they get even a small bend on one corner they do not cut with the same precision and are basically useless.
So, with this new case, I saw the poor embrasure form while I was taking pictures and corrected it.
Here is the final provisional contour the day I seated them.
Here is an composite image showing the initial provisional with the poor embrasure form first. The middle image represents the adjusted provisional embrasure form after shaping with the 7901 carbide and the final seated image shows the provisional with a knife edge type of embrasure form created from the Vision Flex disc.
Here they are a few weeks later when the tissue was healed.
Here are the final restorations immediately after bonding.
Here are the final restorations after 4 months of healing. Note the excellent tissue health and contour. I am glad I caught that mistake I almost committed with the provisional restoration.
The ceramics were created by Master Ceramist Harald Heindl.
If you would like to see this new case in detail with examples of the preparations for Occlusal Veneers, Veneer Crowns, and Onlay Veneers please register for my new webinar while it is still available.
During this new webinar, you will learn:
- Where to start your analysis when a severe wear patient presents into your dental practice. I have a system for this that will help to clarify the confusion surrounding helping these patients.
- How to identify the risks involved with wear patients. Both risk of treatment and the risk of doing nothing.
- How to design and test a new occlusion for these patients. What happens if they cannot tolerate this new Occlusion Design?
- How to manage muscle forces with a wear patient so you can achieve longevity with their restorations.
- How to choose the best restoration design for individual teeth in an erosion or attrition patient. Should you choose crowns, onlays, veneers, occlusal veneers or veneer crowns?
I hope you enjoyed this new email training and look forward to connecting with you during the webinar.