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My patient Fred came to my office looking for a cosmetic enhancement to correct the erosion and wear he was experiencing on his teeth. With a comprehensive examination it was clear he was a terrific candidate for the fall Full Mouth Rehab program with Clinical Mastery. After an initial records appointment, Fred was fitted with a deprogramming release appliance that he wore for several weeks before attending a records clinic. This initial clinic visit of the program included pre-operative analysis of his joint, "mock-up" smile design, open bite Apex of Force records, and the determination to slightly open his vertical dimension. Since, anterior guidance was no longer present a key to long term success of the treatment plan included creating posterior protection by restoring to the Apex of force position and re-establishing anterior guidance. We created a restorative treatment plan, in which I prescribed a 20 unit wax up with the anticipation of approximately 1mm of gingival reduction and further opening of VDO. Fred desired as conservative preparation as possible to meet these goals. This wax up was used as a provisional matrix with a siltech method. We experimented with a maxillary temporary shade close to Fred’s natural tooth color, and a brighter temporary material on the mandibular arch. While Fred’s desire for aesthetics drove the case, the practice experience I gained after attending the Ultimate Occlusion program last June made it clear that Fred's occlusion, existence of parafunction and conditions that caused the initial destruction must be addressed before a cosmetic enhancement could be achieved.

The following photos document the first 2 stages of treatment with the restoration of the upper 10 maxillary and lower 10 mandibular anterior teeth, with his molars to be completed in the next 60 days. Gold Dust did a terrific job on the ceramics, addressing slight cants as well as creating a beautiful aesthetic result for Fred with conservative preparations. Initially, I was concerned about creating a great experience for my patient during a continuing education program. By the completion, it felt more like a family reunion than a CE experience. Thank you Clinical Mastery, Gold Dust and everyone who participated in Fred getting a stunning result with the confidence I have that it will last!

Note: all post op photos are immediate post cementation