The first step of any successful anterior tooth preparation is to treatment plan.
by Dr. Lee Ann Brady
In my last post, I delved into the differences between aggressive, minimal, and “in the middle” tooth preparation approaches. It’s important to acknowledge this spectrum so that we don’t minimize the important differences between each patient’s preparation.
For those creating a preparation style unique to their patient, I’ve put together a basic outline of the first and most important next step.
Treatment Plan 101: Planning to Succeed
Treatment planning is where it all starts. The term “plan” seems so basic, but unfortunately I find that many doctors overlook this aspect or don’t explore it as deeply as they could.
Don’t cripple your case in the long run because you’re afraid the patient will think you’re overselling them. Plan to succeed by planning the aesthetic outcome.
Steps to Determining a Desirable Outcome
Let’s begin our treatment plan with tooth position. Here are some critical aspects to determine:
- The final position of incisal edges.
- Labial and lingual surfaces.
- Alteration to tooth alignment and rotation.
Bonus Tip: It’s very common that we’ll add length to the incisal edge position. This allows us to reduce the amount of reduction required.From a wax-up you can create a mock up of the proposed tooth position over the teeth with provisional material.
With the following steps in place, you can dive into your case with confidence. There’s something to be said for a smooth process and predictable, satisfactory results.
- From a wax-up you can create a mock up of the proposed tooth position over the teeth with provisional material.
- Utilizing a silicone matrix made on the provisional model (I recommend using a stone duplicate of the wax-up), spot etch the labial surface of the teeth to be prepared.
- Fill the silicone matrix with bisacryl and seat over the teeth.
- When fully set, remove the matrix and evaluate the mock-up.
- The material should be extremely thin over the gingival tissue and easy to separate and remove.
- If the material is thick over the tissue it usually indicates the matrix flexed due to pressure when seating and the proportions of the mock up will not duplicate the wax-up.
- If the mock-up is accurate you can now place your depth cuts into the acrylic, thereby knowing you have adequate room for porcelain, without removing unnecessary tooth structure.
In my next post, I’ll explain common alterations you’ll want to make for tooth preparation.
What’s your favorite or least favorite part of the treatment planning process? Let us know in the comments!