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Esthetic and functional long-term prototypes utilizing high-strength bis-acryl resin

May 1, 2020
Dr. Celin Arce says esthetic, functional prototypes are an effective way to evaluate esthetics and function of the proposed restorative plan, while spreading the cost of definitive treatment over time. He demonstrates a direct-indirect technique.

NextGen Leadership Showcase

In this series, we feature articles from the next generation of dental key opinion leaders. Some of the online versions of these articles also feature video interviews with the authors. Find previous articles in the series by Drs. Amisha Singh, Sarah Winter, Nathaniel Lawson, Kathryn DeWood, Albert Ambriz, and Laura Picano on dentaleconomics.com. Search "NextGen."

The esthetic rehabilitation of worn dentition poses a great challenge to clinicians. Several treatment planning approaches and restorative materials are used to treat tooth wear. Clinicians should be able to select the most suitable treatment planning methods and materials for individual patients, depending on their specific etiology and risk factors.1,2

Esthetic functional prototypes have been utilized to test drive the proposed smile design, vertical dimension, phased treatment plan, and functional blueprint for future care.3–5 Different materials and techniques have been used to create bonded functional prototypes, such as polymethyl methacrylate (PMMA) and highly filled flowable composites.6–9

A new generation of bis-acryl resin material is available for fabrication of semipermanent crowns, long-term prototypes, and various uses such as pediatric crowns and palliative care. A university-based study showed flexural strength of approximately 110 MPa and volumetric wear similar to that of conventional composite.10 This article describes a direct-indirect technique to
fabricate esthetic and functional prototypes for full-mouth restorations.

Case description

A patient presented with multiple deficient restorations, discolored teeth, and attrition (figures 1–4). The patient’s treatment plan was a full-mouth rehabilitation with a combination of veneers, crowns, and onlays.

A digital wax-up was designed in the CAD software, and a 3-D printed model was obtained (figure 5). Putty matrices were made using Honigum Pro Putty with Light Body (DMG America), and high-strength bis-acryl resin (LuxaCrown; DMG America) was injected into the matrix (figure 6) and placed in the patient’s mouth over the prepared teeth.
The prototypes were removed, and excess material was trimmed extraorally with carbide finishing burs and polished
(figure 7). After that, prototypes were sectioned in quadrants and then bonded using flowable composite (LuxaFlow; DMG America; figure 8). Occlusion was adjusted as needed, and the bonded prototypes were tested for six months. The final ceramic restorations were finished in a sequenced approach (figures 9–12).
Conclusion

Esthetic and functional prototypes are an effective way to evaluate esthetics and function of a proposed restorative plan, all while spreading the cost of definitive treatment over time. Esthetic, functional, and long-lasting restorations can be achieved if clinical and laboratory protocols are carefully followed using adhesive additive techniques.  

References

1. Calamita M, Coachman C, Sesma N, Kois J. Occlusal vertical dimension: treatment planning decisions and management considerations. Int J Esthet Dent. 2019;14(2):166-181.

2. Fradeani M, Barducci G, Bacherini L, Brennan M. Esthetic rehabilitation of a severely worn dentition with minimally invasive prosthetic procedures (MIPP). Int J Periodontics Restorative Dent. 2012;32(2):135-147.

3. Gürel G, Bichacho N. Permanent diagnostic provisional restorations for predictable results when redesigning the smile. Pract Proced Aesthet Dent. 2006;18(5):281-286.

4. McLaren EA, Schoenbaum TR. The bonded functional esthetic prototype: part 1. Inside Dent. 2013;9(1):70-74.

5. McLaren EA. The bonded functional esthetic prototype: part 2. Inside Dent. 2013;9(5):84-92.

6. Terry DA. Restoring with Flowables. Hanover Park, IL: Quintessence Publishing Co.; 2017.

7. Hemmings KW, Darbar UR, Vaughan S. Tooth wear treated with direct composite restorations at an increased vertical dimension: results at 30 months. J Prosthet Dent. 2000;83(3):287-293. doi:10.1016/s0022-3913(00)70130-2

8. Gürel G, Bichacho N. Permanent diagnostic provisional restorations for predictable results when redesigning the smile. Pract Proced Aesthet Dent. 2006;18(5):281-286, 316-317.
9. Baroudi K, Rodrigues JC. Flowable resin composites: a systematic review and clinical considerations. J Clin Diagn Res. 2015;9(6):ZE18-ZE24. doi:10.7860/JCDR/2015/12294.6129

10. Sulaiman T. Novel semi permanent restorative material, wear, post fatigue, and mechanical properties. University of North Carolina; June 2019.

Celin Arce, DDS, MS, FACP, a board-certified prosthodontist, received his dental degree from University Latina of Costa Rica. He completed a residency in advanced prosthodontics at the University of Alabama (UAB) at Birmingham and a master of science in clinical dentistry. A diplomate of the American Board of Prosthodontics and fellow of the American College of Prosthodontists, Dr. Arce serves as assistant professor of the restorative sciences department at UAB School of Dentistry.
About the Author

Celin Arce, DDS, MS, FACP

Celin Arce, DDS, MS, FACP, a board-certified prosthodontist, received his dental degree from University Latina of Costa Rica. He completed a residency in advanced prosthodontics at the University of Alabama (UAB) at Birmingham and a master of science in clinical dentistry. A diplomate of the American Board of Prosthodontics and fellow of the American College of Prosthodontists, Dr. Arce serves as assistant professor of the restorative sciences department at UAB School of Dentistry.

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