With the popularity of television shows like “Extreme Makeover” and “The Swan,” more and more patients are presenting to dental practices inquiring about enhancing their smiles with porcelain veneers.
The majority of these patients are in their early thirties to late fifties. Because of this growing demand for “beautiful smiles,” many dentists are now marketing their elective cosmetic services to this population, either externally or internally. The rewards to both patient and clinician have been astonishing! However, one group of individuals that may be overlooked in this trend is senior citizens. Many times, these patients have not been informed by their providers of the advances in aesthetic dentistry because of the fear of rejection when presenting cost, presumed health concerns of the patient, or simply age.
Cerinate Lumineers from DenMat introduces an alternative to traditional veneers that can be easily marketed and implemented to this age group. The advantages of this system are the Lumineers can be made as thin as a contact lens and may be placed over existing teeth without having to remove healthy tooth structure. In cases where tooth reduction is necessary, it can be kept conservative. These properties attract many seniors who may be concerned about complications with their medications to local anesthetic or about general health during a routine dental procedure.
Case Study:
Figures:
Fig. 1: Preoperative facial photo of patient
Fig. 2: Preoperative smile photo
Fig. 3: Cerinate LUMINEERS (#6-11)
Fig. 4: Postoperative facial photo of patient
Fig. 5: Postoperative smile photo
A man in his mid-seventies (Figure 1) presented to our practice for a periodic oral exam and cleaning. Upon clinical examination, the patient exhibited acceptable periodontal health. He had evidence of some normal wear on his anterior teeth, but nothing that indicated severe bruxism or grinding. A failing gold foil restoration was present on the incisal edge of tooth #9. There were no caries apparent clinically or radiographically on his maxillary anterior teeth, however the patient was concerned about the cracks and discoloration (Figure 2).
In general, the patient was dissatisfied with his smile and desired a more youthful look that would exhibit straight, bright teeth that would look natural for his age. We reviewed the advantages of utilizing the Lumineers system for enhancing his smile and sparked some more interest in the patient. He was very attracted to the simplicity of the procedures necessary to obtain his goals, and agreed to have a composite mock-up. This mock-up would serve as a blueprint for size, shape, and color of the final restorations, incorporating principles of Golden Proportion.
Once informed consent was obtained from the patient, treatment was initiated by first removing the defective gold foil restoration from tooth #9. Some definitive finish lines were also lightly prepared in enamel to prevent any interproximal darkening because we were altering the shade from D-2 to A-1. During the lab fabrication process, the patient was instructed to apply, stimulate, and rinse with a tissue conditioner, in this case Under the Gum Irrigant from Dental Herb Company. By using this material, the protocols during the cementation process would be met because of the health of his gums. Because the patient had a sensitive gag reflex, a very quickset impression material was selected, Take 1 Super Fast from Kerr Corporation, to take the impression. A stump shade was selected for each tooth to assist the laboratory technician in creating natural-looking restorations (Figure 3).
Before try-in of the Cerinate restorations, the teeth were pumiced with Preppies Paste to remove any contaminants from the enamel surface. Once the fit was verified, a try-in paste was used to see if the patient was satisfied with the proposed color. After acceptance of the color was achieved, cementation protocols were immediately followed using the Tenure® and Ultra-Bond® Plus (A-1 Shade) luting system from DenMat. Using an LED curing light, the restorations were tacked at the gingival margin. While the restorations were firmly held still in place, the restored dentition was flossed and any excess cement was removed. When most of the excess cement was removed, the restored dentition was completely light cured from both sides. Any residual cement was removed with a No. 15 scalpel or finished with a fine diamond and polishing points. After complete polymerization of the restorations, the occlusion was verified and adjusted. The overall health and structure of the soft tissue and restorations was very good. The patient was extremely satisfied with the final results (Figures 4 & 5).
Conclusion:
All patients deserve to feel understood and get what they want, regardless of their age. Having a variety of different aesthetic materials to choose from allows the clinician to select the most appropriate restorative material necessary to overcome that obstacle. In this particular case it was Cerinate Lumineers from DenMat that assisted us in meeting the aesthetic demands of the patient.