I wanted to write a blog post to teach you about a critical step that I feel will really transform your smile design cases for your patients.

When I look back at all of the beautiful smiles that I am fortunate to create for my patients I concluded that one of the steps in my system that has been critical to success is the provisional evaluation appointment.

We all know that the provisional restorations are critical for the ceramist to use as the guide when creating the final porcelain restorations. The potential for a problem happens because the provisional is the last step for the preparation appointment and if you are running out of time can be rushed or not properly evaluated. This is compounded by the patient having a lack of natural lip mobility due to any remaining local anesthetic and fatigue from the entire preparation, impression and provisional process. At this stage of the appointment, many patients just want to get out of the chair.

With all of this in mind I added a provisional evaluation appointment as a critical step in my system for smile design and rehabilitation cases.

I have been using this appointment for the last 18 years and it has allowed both myself and the patient a more relaxed and ideal time together to evaluate not only the occlusion but the esthetics of the provisional results.

This appointment is the time to make any changes in the occlusion design and incisal edge position BEFORE the ceramist starts to build the final restorations.

My system is to have the patient return anywhere from 1 to 2 weeks after the preparation date and evaluate the provisional results and make any desired changes to the case. If the provisional looks great or the changes are minor I will take a final provisional impression, bite records and digital photo series of the provisional results.

If the changes are significant I will have the patient go a few more weeks to evaluate the changes and then have a second provisional evaluation appointment.

I would like to share a recent case with you that illustrates a good lesson.

This patient was treatment planned for 7 Emax restorations for the maxillary anterior.

The first step after the functional analysis and treatment planning was to alter the gingival tissue levels.

After healing a new maxillary model was taken and mounted on the Sam 3 articulator to complete the diagnostic wax-up.

The patient came into the office for the preparation appointment and the old restorations were removed, new core build-ups placed and the final preparation impression and provisional restorations were created.

The patient returned to my office 2 weeks later for the provisional evaluation appointment. Due to traffic issues the patient was very late for this appointment but he told me that he was very happy with the results of the provisional restorations.

With this in mind I took a quick look at the results and decided it looked good to me as well. I checked the occlusion, discussed the shade and took the digital photo series. I then left the case with my assistant to take the final impression of the provisional.

The next day I was looking over the models and photos of the case preparing everything to send to my master ceramist, Harald Heindl. At this point I realized that I missed the fact that the incisal edge position was slightly canted and down on the right side. Even with the patient being late I should have taken more time on the provisional evaluation appointment.

The patient told me the day before that he was happy with these results but when I reviewed them I realized that this could be dramatically improved.

The decision was made to bring the patient back for a second provisional evaluation appointment so I could shorten the right side and level out the incisal edge position.

In a case like this one where the change is not that extensive I will shorten the incisal edge on the right side with Soflex XT discs, reevaluate the results and retake the provisional records.

The case was then sent to Master Ceramist Harald Heindl and completed with layered Emax crowns.

The moral of this story is that a critical evaluation of the provisional restorations is important for our cases even if the patient is late or you are behind and have a patient waiting in another chair.

Let me know if you have any questions or comments using the link above this post and if you like the written blog post format.

Thank you again for being a member of my online community and remember, you can do this kind of dentistry! Beautiful dentistry with precise fit and occlusion is not just for the gurus.

All the best, Stephen