Red or White? Aremovable combination work challenges the dental technician on many levels, from. Part 1. Construction, function and aesthetics

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1 Construction, function and aesthetics Red or White? Part 1 MDT Haristos Girinis, Nagold For a complex implant supported restoration like the one discussed in this article, the dental technician has to apply all his capabilities: Construction, function and aesthetics. MDT Haristos Girinis demonstrates how to solve such a challenging case. Contents: aesthetics, function, implant prosthetics Aremovable combination work challenges the dental technician on many levels, from the smallest ceramic veneer to the largest implantological reconstruction. From the wax set-up and the casting technique to the milling process, this specific task faces a variety of difficult challenges. Furthermore, the handling of different materials like acrylic, ceramic and metal has to be mastered, quite a challenge in our profession. Our goal is to find clinical long-term solutions for the patient. Even though we are considered craftsmen and have to master all required procedures, it is equally important that the communication between dentist, technician and patient remains open. Especially in implantology, a close relationship between laboratory and dental clinic is essential. The main focus is the patient and restoring his quality of life. Comfort is an important factor for the patient functionally and aesthetically, and has to be part of the reconstruction so that he can lead and enjoy an active life. Once all these requirements have been fulfilled it is always a welcome surprise when the feedback for a job well done is the big smile on the patient s face. 14 dental labor international plus Vol. 3 No. 5 October 2011

Figures 1 to 3 Initial situation Figure 4 The occlusion needs strong corner posts Figure 5

joint Initial situation and analysis A 74 year old quite skeptical patient presented himself

After a closer look we discovered additional defects (Figure 2).

We look at the tooth axes, arches and curves and try to get as much information as possible.

prosthesis, which did not live up at all to its quality seal Made in Germany (Figure 3).

The existing tilted position was a clear indication that acrylic was not a suitable material

Strong corner posts, like ceramic teeth, were needed for a proper occlusion (Figure 4).

2 Figures 1 to 3 Initial situation Figure 4 The occlusion needs strong corner posts Figure 5 Progenic positioning Figure 6 Anatomic impression Figure 7 The bar is cut after the connecting joint Initial situation and analysis A 74 year old quite skeptical patient presented himself (Figure 1). We noticed right away that he was missing a lot of teeth. After a closer look we discovered additional defects (Figure 2). Before any new restoration work it is vital to look at the person as a whole. We look at the tooth axes, arches and curves and try to get as much information as possible. Initially the patient had difficulties opening his mouth, thus hiding his fairly new prosthesis, which did not live up at all to its quality seal Made in Germany (Figure 3). Cusps and fossas were barely visible and a proper occlusion was non-existent. The existing tilted position was a clear indication that acrylic was not a suitable material for a longterm accurate occlusion. Strong corner posts, like ceramic teeth, were needed for a proper occlusion (Figure 4). Furthermore we noticed a slight progenic bite (Figure 5). How this happened is unknown, in this case it was not clear, which one was the maxilla or mandibula restoration, despite the fact that they were both 5 years old. dental labor international plus Vol. 3 No. 5 October

Figure 8 Wings serve as retentions for the impression material Design We

In the mandibula two canine teeth were present.

The two canines in the mandibula were left for the temporary phase.

impression posts in place, which we will then replace with the implant posts

These were individualized with Pattern resin and connected with a bar.

serve as retentions for the impression material in the closed tray impression

3 Figure 8 Wings serve as retentions for the impression material Design We informed the patient that work needed to be done in the maxilla as well. In the mandibula two canine teeth were present. Our patient wanted a stable, removable restoration, similar to his wife s. The two canines in the mandibula were left for the temporary phase. Afterwards two implants were placed in the area of the number two and number four teeth. Preparation in the dental clinic First we took an anatomic impression with the impression posts in place, which we will then replace with the implant posts (Figure 6). These were individualized with Pattern resin and connected with a bar. We cut the bar in several places and attached small wings (Figure 7), which serve as retentions for the impression material in the closed tray impression (Figure 8). The dentist applied those Pattern aids orally before Fig.9 Fig.10 Fig.11 Fig.12 Figures 9 to 12 Removable gingival mask made of pu-acrylic Figure 13 Acrylic control key with metal support Figure 14 Verification of the control key 16 dental labor international plus Vol. 3 No. 5 October 2011

4 Fig.16 Figure 15 The old prosthesis aids with the maxillomandibular relationship record Figures 16 and 17 The wax set-up with positioning screws Fig.17 Screws serve as static stabilizers during try-in Figure 18 Try-in Figures 19 and 20 Lengthening of the anterior teeth in wax Figures 21 and 22 Set-up of the mandibula dental labor international plus Vol. 3 No. 5 October

Figure 23 Modelled gingival Figures 24 to 26 Orange peel effect

the impression and very important connected the bars with Pattern

Removable gingival mask After taking the impression, we created a

It is very important to leave enough space for the plaster material to

positioned, therefore creating needed stability.

Control key Then we created an acrylic control key with metal support

5 Figure 23 Modelled gingival Figures 24 to 26 Orange peel effect Figures 27 and 28 Cleaned and polished ready for duplicating taking the impression and very important connected the bars with Pattern resin. Removable gingival mask After taking the impression, we created a removable gingival mask made of pu-acrylic (picodent) in the implant area (Figures 9 to 12) to individually design the emergence profile on the implants. It is very important to leave enough space for the plaster material to ensure that the model abutments of the implants are properly positioned, therefore creating needed stability. That is how we fabricated our working model. Control key Then we created an acrylic control key with metal support on the working model (Figure 13) and connected the abutments with Pattern resin. We then checked the positioning of the control key with an x-ray (Figure 14) Figure 29 Matrix to capture the situation 18 dental labor international plus Vol. 3 No. 5 October 2011

and concluded that the model was accurate.

Wax set-up and try-in We did a wax set-up with acrylic teeth to visualize the dimensions.

bite. We realized during try-in (Figure 18) that functional and aesthetic adjustments were needed in the maxilla.

Final set-up We started with the lengthening of the anterior teeth in wax (Figures 19 and 20), followed by a set-up with the mandibula (Figures 21

Modelling of the gingival Once everything was verified and approved, we began with the modelling of the gingival (Figure 23).

6 and concluded that the model was accurate. The old prosthesis, serving as a maxillomandibular relationship record, was placed in the articulator (Figure 15). Wax set-up and try-in We did a wax set-up with acrylic teeth to visualize the dimensions. The wax set-up had positioning screws (Figures 16 and 17) to keep the set-up statically stable in situ during try-in so that we were able to take the bite. We realized during try-in (Figure 18) that functional and aesthetic adjustments were needed in the maxilla. The try-in is an important design platform that offers much information. Final set-up We started with the lengthening of the anterior teeth in wax (Figures 19 and 20), followed by a set-up with the mandibula (Figures 21 and 22) from function to aesthetics. Modelling of the gingival Once everything was verified and approved, we began with the modelling of the gingival (Figure 23). We started by pressing a prosthesis brush hard into the wax (Figures 24 and 25) followed by the use of an alcohol torch on low flame. The result was the typical orange peel effect (Figure 26). Once cleaned and polished (Figures 27 and 28) the work was ready for duplicating. Figure 30 The capillary effect forces the embedding material into the channels thus avoiding metal penetration Figure 31 Transformed into a precious metal alloy Figure 32 Premilling along the gingival line Figures 33 and 34 Plastic wrap protects the model from debris dental labor international plus Vol. 3 No. 5 October

The red and white areas were designed perfectly and we were

on (Figure 29). We were now ready to visualize our next step.

and milled then sprued for the casting process and embedding

guides the embedding material into the channels (Figure 30) to

31) followed by milling with a parallel milling bur along the

of the silver conductive lacquer Figures 38 and 39 Precise fit

7 The red and white areas were designed perfectly and we were able to capture the situation with matrices for our work later on (Figure 29). We were now ready to visualize our next step. Abutments The castable HSL-abutments were attached with wax and milled then sprued for the casting process and embedding aids were applied, thus creating a capillary effect that guides the embedding material into the channels (Figure 30) to avoid metal penetration later on. This is a very important step! The transformation was done in a precious metal alloy (Figure 31) followed by milling with a parallel milling bur along the Figure 35 Master model Figures 36 and 37 Minimal clearance fit of the silver conductive lacquer Figures 38 and 39 Precise fit Figures 40 and 41 The primary component is positioned with a template 20 dental labor international plus Vol. 3 No. 5 October 2011

Figure 42 Laboratory abutments Figures 43 and 44 with base Figures 45 and 46 Duplicated model Figure 47 Design model

Plastic foil was used to protect the model from oil and milling debris (Figure 33) and to prepare the surface (Figure

Secondary components For the fabrication of the secondary components, we chose the galvano electroforming technique with

Because of the minimal clearance fit of the silver conductive lacquer (Figures 36 and 37) we achieved a very accurate

With the aid of a template (Figures 40 and 41) the primary component was fitted in the mouth and placed with the

This was our precious precision model on which we would glue the secondary component, the structure, in the end.

8 Figure 42 Laboratory abutments Figures 43 and 44 with base Figures 45 and 46 Duplicated model Figure 47 Design model gingival line (Figure 32). Plastic foil was used to protect the model from oil and milling debris (Figure 33) and to prepare the surface (Figure 34). We were able to forego the milling model and could check the abutments directly on the working model (Figure 35). Secondary components For the fabrication of the secondary components, we chose the galvano electroforming technique with a thickness of 0.2 mm. Because of the minimal clearance fit of the silver conductive lacquer (Figures 36 and 37) we achieved a very accurate fit (Figures 38 and 39). Reinforcement with a metal-supported structure is advisable, but more on that subject later. With the aid of a template (Figures 40 and 41) the primary component was fitted in the mouth and placed with the laboratory abutments (Figure 42) using a base stone with minimal expansion (Figures 43 and 44). This was our precious precision model on which we would glue the secondary component, the structure, in the end. Now we returned to our duplicated model (Figures 45 and 46), the design model with maxilla (Figure 47) for which we chose ceramic teeth, to be exact pressed ceramic veneers, that needed to be individualized with colour, as initially discussed with the patient and dentist. n to be continued in the next issue dental labor international plus Vol. 3 No. 5 October

Design, function and aesthetics Red or White? Part 2 MDT Haristos Girinis, Nagold In a three-part article, MDT Haristos Girinis demonstrates the fabrication of a complex implant supported restoration.

Contents: aesthetics, function, implant prosthetics The path to white aesthetics First we determine the gingival margin on the model (Figure 48) and grind all teeth with the help of the matrix

9 Design, function and aesthetics Red or White? Part 2 MDT Haristos Girinis, Nagold In a three-part article, MDT Haristos Girinis demonstrates the fabrication of a complex implant supported restoration. The first part deals with the wax-up, the fabrication of the abutments and the secondary components. The creation of the white aesthetic is also discussed in this article. Contents: aesthetics, function, implant prosthetics The path to white aesthetics First we determine the gingival margin on the model (Figure 48) and grind all teeth with the help of the matrix (Figure 49). The situation is frequently checked in the articulator (Figures 50 and 51) ensuring that there is enough space. Figure 48 The gingival margin is defined on the model Figure 49 The teeth are ground with the help of the matrix 38 dental labor international plus Vol. 3 No. 6 December 2011

Figures 50 & 51 Verification in the articulator Figures 52

bite-taking with the models (Figure 52).

and create the saw model in the usual way (Figure 54).

On the unsawn base model that is also in the articulator,

After verification the wax modellation is converted to

The entire mandibula, with the pressed ceramic teeth in

Figure 54 Saw model Figures 55 & 56 Modelling of the wax

10 Figures 50 & 51 Verification in the articulator Figures 52 & 53 Technical bite-taking We generate a technical bite-taking with the models (Figure 52). We then place everything into the articulator (Figure 53) and create the saw model in the usual way (Figure 54). Next, the wax teeth are modelled and transferred on the base model (Figures 55 and 56). Figure 57 clearly shows the curve and arch of the tooth. On the unsawn base model that is also in the articulator, all functions are verifiable (Figures 58 to 60). After verification the wax modellation is converted to pressed ceramic teeth (Figures 61 and 62). The entire mandibula, with the pressed ceramic teeth in place, displays a stable occlusion (Figure 63). Figure 54 Saw model Figures 55 & 56 Modelling of the wax teeth Figure 57 Clearly noticeable from the approximal side: the curve and the arch of the tooth dental labor international plus Vol. 3 No. 6 December

11 Figures 58 to 60 All functions are verified on the unsawn base model Figures 61 & 62 Sprued and pressed ceramic crowns Figure 63 Stable occlusion in press ceramic Figures 64 to 66 Just like natural teeth: the fluorescence of the press ceramic Figure 67 The fissures and ridges of the individual tooth Figure 68 The perikymata (growth lines) 40 dental labor international plus Vol. 3 No. 6 December 2011

Aesthetic press-ceramic The fluorescence of the press-ceramic is very

Now we apply ridges and fissures to each tooth (Figure 67).

process each one individually (Figure 69).

removed with a rubber wheel (Figure 71).

The occlusion is again checked in the articulator, first on the saw

The next step is the refinement of the crowns using a delicate paint

The transmittedlight-images displayed in Figures 79 and 80 demonstrate

Figure 69 Each tooth is prepared individually Figure 70 The surface

12 Aesthetic press-ceramic The fluorescence of the press-ceramic is very similar to that of natural teeth (Figures 64 to 66). Now we apply ridges and fissures to each tooth (Figure 67). The surface perikymata is created by circular motions during processing (Figure 68). To assure that each tooth has its individual shape and texture, we process each one individually (Figure 69). We treat the surface with fine-grade sandpaper to create a velvety finish (Figure 70). For the imitation of nature-identical abrasion, protruding points are removed with a rubber wheel (Figure 71). The contact points can be precisely determined (Figure 72). The occlusion is again checked in the articulator, first on the saw model and finally on the control model (Figures 73 to 75). The next step is the refinement of the crowns using a delicate paint technique (Figures 76 to 78). The transmittedlight-images displayed in Figures 79 and 80 demonstrate the superb fluorescent characteristic. Figure 69 Each tooth is prepared individually Figure 70 The surface receives a velvety finish with fine-grade sand paper Figure 71 A nature-identical abrasion Figure 72 The contact points are determined Figure 73 Verification of the occlusion in the articulator, Figure 74 on the saw model Figure 75 and on the control model Figures 76 to 78 The tastefully painted crowns dental labor international plus Vol. 3 No. 6 December

Figures 79 to 80 Impressive fluorescence Figure 81 Support for the white and red aesthetic

aesthetic Figure 83 Before the embedding process the separated structure is reattached

acrylic design Bracket structure Now the white and red aesthetics need a bracket (Figure

mandibula. This displays an accurate white and red aesthetic margin (Figure 82).

casting process we achieve the result we wanted (Figures 84 and 85)!

13 Figures 79 to 80 Impressive fluorescence Figure 81 Support for the white and red aesthetic restoration Figure 82 The material pattern resin displays the exact margin of white and red aesthetic Figure 83 Before the embedding process the separated structure is reattached Figures 84 & 85 Sabath casting technique: the cast structure conforms exactly to the acrylic design Bracket structure Now the white and red aesthetics need a bracket (Figure 81) and a tertiary structure for the primary copings made of galvano gold. This bracket ensures stability. The teeth of the mandibula are fixed to the maxilla then pattern resin is applied in the mandibula. This displays an accurate white and red aesthetic margin (Figure 82). The construction is separated and before embedding reattached on the model to guarantee a tension-free fit (Figure 83). By using the Sabath casting technique ( without a cast cone), we ensure that after the casting process we achieve the result we wanted (Figures 84 and 85)! After finishing, the work is verified on one of our important verification tools, the precision model (Figure 86): the margin of the white and red aesthetics is very noticeable. Figure 86 Verification on the control model 42 dental labor international plus Vol. 3 No. 6 December 2011

Figures 87 to 89 The structure is sandblasted with 110

teeth in the transfer key are etched and silanized The

coating with opaquer and powder to bond the dispersion

proceed with the etching and silanization (Figures 90 to

fixed on the tertiary structure with polymer material

The white aesthetic is securely attached to the bracket

14 Figures 87 to 89 The structure is sandblasted with 110 µm, coated with opaquer and powder Figures 90 to 92 The teeth in the transfer key are etched and silanized The structure is sandblasted with 110 µm followed by a coating with opaquer and powder to bond the dispersion layer and to create a rough surface for the adhesion later on (Figures 87 to 89). A crystalline surface ensures that the metal structure will not be noticeable in the future. After the teeth are placed in the transfer key, we proceed with the etching and silanization (Figures 90 to 92). With the transfer key the pressed ceramic teeth are fixed on the tertiary structure with polymer material (Figure 93). The white aesthetic is securely attached to the bracket and the white and the red area is perfectly defined (Figures 94 and 95). n Figure 93 The pressed teeth are fixed on the tertiary structure with polymer material to be continued in the next issue Figures 94 & 95 A secure fit on the bracket dental labor international plus Vol. 3 No. 6 December

Design, function and aesthetics Red or White? Part 3 MDT Haristos Girinis, Nagold In a three-part article Haristos Girinis explains the fabrication of a complex implant-supported restoration.

15 Design, function and aesthetics Red or White? Part 3 MDT Haristos Girinis, Nagold In a three-part article Haristos Girinis explains the fabrication of a complex implant-supported restoration. The following third part focuses on red aesthetics. Contents: aesthetics, function, implant prosthodontics, red aesthetics, white aesthetics In the previous part we completed the white aesthetics; now we create the red aesthetics. First, all details are accurately modeled in wax (Figure 96), thus ensuring a perfect realization in acrylic afterwards. We have two design options: ceramic for fixed restorations and acrylic for removable prosthetics. Acrylic offers significant advantages in terms of hygiene and is easy to repair. For projects that need to adjust a vertical gingival deficit, acrylic is the preferred material. Acrylic a lifeless material? The fabrication of white aesthetics is mastered perfectly by many dental technicians, whereas the red aesthetics still seems to be the poor cousin in the field of dental aesthetics. Acrylic is a rather lifeless material therefore we dental technicians need to lend this material a sense of liveliness, which is quite a difficult task. First it is very important to accurately model all details in wax, like papilla characteristics, cheek fraenum, orange skin effect etc (Figure 97). It demands a basic knowledge of anatomy and materials. Once all details are properly modeled in wax, the transformation in acrylic should be problem-free. We apply low viscosity silicone with a cartridge (Figure 98) to capture even the smallest details in the vestibular and the lingual region. Then the silicone is coated with a pliable silicone (Figures 99 and 100). The matrix should display all details that were incorporated into the wax. 28 dental labor international plus Vol. 4 No. 1 February 2012

Figure 96 Details are modeled into the wax beforehand Figure 97 An important detail: orange skin surface Figure 98

appearance (Figure 103). The excess is blasted off (Figure 104) before we proceed with the final curing.

16 Figure 96 Details are modeled into the wax beforehand Figure 97 An important detail: orange skin surface Figure 98 Low viscosity silicone material is applied Red Aesthetics Aesthetics always means the overall impression of red and white. For white aesthetics we use white or light materials, while we choose reddish materials for the red aesthetics (Figure 101). To cover the structure we apply pink opaquer all over including the tiniest papilla tip, followed by a generous powdering (Figure 102). It prevents the formation of a dispersion layer and we create a diffuse, crystalline surface for a natural appearance (Figure 103). The excess is blasted off (Figure 104) before we proceed with the final curing. Once completely hardened, the look of fine capillaries is simulated with ceramic colors and fixed with liquid opaquer (Figures 105 and 106). Because of the acrylic components lighter spots are created on the papillas, generating a natural and high-contrast display of colors. Prior to finishing, the structure is bonded to the abutments AGC-Cem (Wieland) on the precision model (Figure 107). This process is an important step and needs to be executed accurately and neatly, as demonstrated in Figure 108. Figures 99 and 100 The matrix reproduces every detail Figure 101 Reddish looking material for the red aesthetics dental labor international plus Vol. 4 No. 1 February

17 Figures 102 and 103 The opaquer is powdered on giving the crystalline surface a natural appearance Figure 104 After curing Figures 105 and 106 Fine capillaries are simulated and fixed with liquid opaquer Figure 107 Bonding of the framework to the abutments Figure 108 A clean and successful bonding 30 dental labor international plus Vol. 4 No. 1 February 2012

Characterization Now we start with the characterization of the gingiva with the colours ruby, topaz and opal-white by Merz Dental

To simulate a natural mucosa we have to imitate natural movements. The highly inflexible acrylic material poses quite a challenge.

We start by applying slightly bluish and reddish paint with a small brush to the movable part of the mucosa; in the transition area

The rough texture of the matrix is advantageous because the acrylic material adheres perfectly to it (Figures 115 and 116).

Polymerization only starts once the monomer is applied.

displayed and the orange skin effect is well Figure 109 Colours for the individualization of the gingiva Figure 110 Two-part matrix

18 Characterization Now we start with the characterization of the gingiva with the colours ruby, topaz and opal-white by Merz Dental (Figure 109). The matrix (Figure 110) was designed in two-parts, also from the buccal and lingual region. To simulate a natural mucosa we have to imitate natural movements. The highly inflexible acrylic material poses quite a challenge. The fixed gingiva area is less colorful, rather whitish and has an almost anemic appearance (Figures 111 to 114). We start by applying slightly bluish and reddish paint with a small brush to the movable part of the mucosa; in the transition area between the movable and fixed mucosa we incorporate a bit of yellowish colour and towards the fixed mucosa we apply white powder. The rough texture of the matrix is advantageous because the acrylic material adheres perfectly to it (Figures 115 and 116). Tip: transfer the monomer into a small bottle equipped with a needle and use it to lightly moisten the applied color (Figure 117). Polymerization only starts once the monomer is applied. For verification purposes the matrix is attached to the model with the acrylic, showing a remarkable result: All colors are nicely displayed and the orange skin effect is well Figure 109 Colours for the individualization of the gingiva Figure 110 Two-part matrix Figures 111 to 114 For the moving part of the mucous membrane a bluish, reddish colour is applied. In the transition area to the fixed mucosa a little yellowish colour is applied and towards the fixed mucosa white powder is dusted on dental labor international plus Vol. 4 No. 1 February

19 Figures 115 and 116 The material bonds well to the matrix Figure 117 Application of monomer with a needle Figures 118 to 120 The incorporated colours and the orange skin effect are nicely reproduced Figure 121 No bite elevation Figure 122 The compression lug is dislodged 32 dental labor international plus Vol. 4 No. 1 February 2012

bite elevation (Figure 121), only a minimal shifting.

the polymerization lug is dislodged with a scalpel.

instruments tend to tear the acrylic and make polishing

We are now ready to polish the papilla with trippelpaste and

20 preserved (Figures 118 to 120). The advantage of this technique is that it does not create bite elevation (Figure 121), only a minimal shifting. A final verification in the articulator confirms that everything is in order. Detail work and finish Now we start the detail work (Figures 122 and 123). The septa are carefully unblocked up to the contact point and the polymerization lug is dislodged with a scalpel. We do not use a round bur or anything similar as these instruments tend to tear the acrylic and make polishing difficult. We are now ready to polish the papilla with trippelpaste and polishing wheel (Figures 124 to 127) problem-free without damaging the teeth. Figure 123 The septa are unblocked Figures 124 to 127 The papillas are polished with trippelpaste and a polishing wheel Figures 128 to 130 After polishing, the colour variations are nicely accentuated. The gingiva adapts perfectly to the teeth dental labor international plus Vol. 4 No. 1 February

21 Figures 131 to 134 The light accentuates the effects Figure 135 The image by transmitted light displays the supporting structure Figure 136 It presents itself as one unit to the patient Figure 137 Red and white aesthetic Figure 138 The details are a good indication of the work involved 34 dental labor international plus Vol. 4 No. 1 February 2012

After a thorough polishing the acrylic gingiva adapts perfectly to the teeth without corners or edges that might encourage the accumulation of food deposits.

Depending on the incidence of light, depth and individual effects are perfectly displayed (Figures 131 to 134).

All he sees is one complete unit (Figure 136). Conclusion The red and white aesthetics can be viewed from different angles (Figure 137).

The basal region has to be completely neat and smooth (Figure 139) for hygienic and maintenance reasons. Overall the result is a masterful Made in Germany reconstruction (Figure 140).

22 After a thorough polishing the acrylic gingiva adapts perfectly to the teeth without corners or edges that might encourage the accumulation of food deposits. After a high gloss polishing (Figures 128 to 130) the beautiful play of colours, which we created by incorporating a variety of shades, is far more impressive. Depending on the incidence of light, depth and individual effects are perfectly displayed (Figures 131 to 134). The image by transmitted light shows the supporting structure (Figure 135), which is completely invisible to the patient due to the previously described work steps. All he sees is one complete unit (Figure 136). Conclusion The red and white aesthetics can be viewed from different angles (Figure 137). One realizes how much skilled work and effort is needed to achieve such detailed forms and profiles (Figure 138). The basal region has to be completely neat and smooth (Figure 139) for hygienic and maintenance reasons. Overall the result is a masterful Made in Germany reconstruction (Figure 140). The piece is placed in the articulator for a final verification (Figure 141): we are presented with our work from design and set-up to wax-up including the necessary adjustments to the finished prosthesis. In situ Our patient is quite anxious; he wants to find out if his new prosthesis offers any improvement (Figure 142). Because of the implantation, everything took a little longer than planned (Figures 143 to 144) and our team is also anxious to see what the restoration will look like once it is placed in the patient s mouth. Did we implement the design properly? Did we meet the patient s needs (Figures 145 to 150)? The prosthesis integrates perfectly in the oral environment (Figure 151). We are pleasantly surprised by what can be incorporated into such a thin reconstruction. Figure 139 To ensure good hygiene the basal section needs to be completely smooth Figure 140 The perfectly polished prosthesis The result is more than satisfactory. He is finally able to smile again, aesthetics and function have been restored and giving him the confidence he needs in social situations definitely a gain in his quality of life (Figures 152 to 154). Figure 141 Final verification in the articulator Figure 142 The patient is waiting anxiously for the result dental labor international plus Vol. 4 No. 1 February

23 Figures 143 to 145 A long process: from the initial situation to the implantation Figures 146 to 151 but the result reveals: the patience paid off 36 dental labor international plus Vol. 4 No. 1 February 2012

Figures 152 to 154 The satisfied patient can finally smile again with confidence Final conclusion We are now able to answer the initially asked question: Red or

This article demonstrates that only with new and approved materials can we create such complex and highstandard work.

It requires mutual understanding and it depends on the patient s financial aspect.

24 Figures 152 to 154 The satisfied patient can finally smile again with confidence Final conclusion We are now able to answer the initially asked question: Red or White? Basically it is a harmonious interaction of many elements. This article demonstrates that only with new and approved materials can we create such complex and highstandard work. Of course the communication between technician, dentist and patient is absolutely essential. A lot of effort goes into this kind of work. It requires mutual understanding and it depends on the patient s financial aspect. n Material: Plaster: Fuji Rock White (GC), Supersockler (Picodent) Gingival mask: picopoly (Picodent) Pins: SAM Artificial teeth: Merz Dental Prosthesis acrylic: Prothetik Colour System (Merz Dental) Implant system: Metalor Dental Alloy: Galileo (Jensen), Eurogold Supra (Wieland Dental + Technik) Press ceramic: Wieland Dental + Technik Stones: TC4 (Shofu) dental labor international plus Vol. 4 No. 1 February

SPECIAL REPRINT c Light and Shadow by Haristos Girinis, Nagold B 2129 E. Die ganze Welt der Zahntechnik.

SPECIAL REPRINT c Light and Shadow by Haristos Girinis, Nagold B 2129 E. Die ganze Welt der Zahntechnik. B 2129 E Die ganze Welt der Zahntechnik SPECIAL REPRINT c by Haristos Girinis, Nagold www.wieland-international.com WIELAND Dental +Technik GmbH & Co. KG Schwenninger Straße 13, 75179 Pforzheim, Germany