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Mastering Minimally Invasive Esthetics

A Step-by-Step Guide

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Let's Get Started!

You are about to transform your patient’s smile by using ART (Additive-Reductive Template), a minimally invasive approach to Smile Design. With ART you and your patient will be able to preview the final restoration before the porcelain is fabricated. This step-by-step guide will assist you through the entire process, from the receipt of your ART design case, through the shipment of the final impression back to Robertson Dental Lab. 
Download RX Forms Here
Print Shipping Labels Here

1. Unpack and Organize

Upon receipt of your ART lab case, familiarize yourself with the contents of the box. Review all of the case items and separate them between the lab communication/production items, and those items which you will use during your Patient Case Presentation.

Models

Lab Communication/Production

These are  items you will use to prepare the teeth (if applicable) and create the Trial Smile.

Wax Model

Patient Case Presentation

This is what you will present to the patient to demonstrate the design.

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Lab Rx and Shipping

These are items required for shipping the lab case back to Robertson Dental Lab for production of the final restorations.

2. Design Review

Review the case design as shown on the Waxed Model. If the case design calls for any changes to the patient’s existing dentition, these changes will be illustrated on the color-coded Strategic Prep Model. Because ART is a minimally invasive approach, in most cases, adjustments to existing dentition are generally limited to enamel only. The color-coded Strategic Prep Model will indicate all required modifications or contouring to achieve the design shown on the Waxed Model.

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3. The Patient Appointment

Present the custom Waxed Model to the patient. The design is intended to deliver maximum esthetics with a minimally invasive approach. Ensure that the design meets your patient’s expectation for their new smile. If applicable, explain to the patient that you will be making some minor adjustments and or contouring to their existing dentition, in order to accommodate the restorations. Unlike a traditional preparation for veneers, in most Lumineers® ART cases, modifications will be limited to enamel, thereby maintaining healthy tooth structure. You can utilize the color-coded Strategic Prep Model to communicate this to the patient.

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4. Contouring and Adjustments

If applicable, use the green ART templates to contour or adjust the dentition. Ensure that you are utilizing the templates in the numbered sequential order, following the color-key illustrated for the Strategic Prep Model (see Step 2 Design Review).

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Strategic minimal reduction utilizing the green ART templates
Strategic minimal reduction utilizing the green ART templates
Strategic minimal reduction utilizing the green ART templates
Strategic minimal reduction utilizing the green ART templates

5. Final Adjustments & Softening

Final Adjustments/Softening Adjustments made with the green ART templates will result in ledges, sharp corners, and angles on the teeth. As illustrated in orange on the color-coded Strategic Prep Model, remove these by using a free-hand prep technique. The final adjustments are meant to be a “softening” of the areas where reduction was performed in addition to the rounding and rolling of the embrasures, if needed. In some cases, a beveling of the facial incisal area is required. If so, this would be indicated on the Strategic Prep Model in grey-colored lines.

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Accurate free-hand softening is needed to minimize sharp line angles and chance for stress fractures.

6. Gingival Reshaping (if applicable)

In some cases, gingival reshaping is required in order to achieve a symmetrical result. If needed, follow the color-coded Strategic Prep Guide model and contour the soft tissue where applicable, using a soft tissue diode laser such as the NV® PRO3 or the SOL® laser by DenMat. A soft tissue laser will allow for immediate impressions to be taken because the tissue should demonstrate minimal to no tissue damage and no bleeding. Do not attempt to take impressions if the tissue is hemorrhaged and or bleeding, as this will create distortion.

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Soft tissue contouring will ensure optimal esthetics.

7. Trial Smile

You are now ready to create the Trial Smile.

  • Step 1: Use the clear Trial Smile Matrix provided and fill with PerfecTemp10® by DenMat, or any high-end provisional material. When filling the Matrix, start at one end and extrude the material along the facial one-half of each tooth, keeping the delivery tip submerged to insure each tooth space is covered.
  • Step 2: Dry teeth, and immediately seat the filled Matrix and hold in place over the prepared teeth.  
  • Step 3. If using PerfectTemp10, allow the material to cure for 2 to 2-1/2 minutes in the mouth, or as otherwise directed by the material manufacturer’s instructions. Remove the Matrix and allow full polymerization of the material before polishing or contouring.
  • Step 4:  Clean and polish the Trial Smile.     
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Ultra-clear Trial Smile matrix provides visual placement and ensures accuracy.

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Ultra-clear Trial Smile matrix provides visual placement and ensures accuracy.

8. Trial Smile Review

Now you have the opportunity for both you and your patient to review the Trial Smile in place. Patient approval and acceptance starts now! Most patients will love the design, leaving only your clinical review to complete the approval process. If any changes to the Trial Smile are desired, you can do so using a 16 long fine fluted yellow striped burr. These changes could include length, anatomy or incisal edge adjustments. Once the new smile meets all esthetic expectations of your patient, continue to the clinical review steps below.

Check all facial areas of the Trial Smile to insure there is no tooth shine-through, which would indicate additional tooth contouring is needed in order to prevent thin spots.

Ensure there are no occlusal interferences and that there is adequate incisal/occlusal clearance for restorations.

Important! Before you remove the Trial Smile for final impressions, now is the time to record any changes to the Trial Smile by doing the following:

  • Make a Study Model by taking an impression
    and immediately pouring a model of the approved Trial Smile.
  • Take unrestricted full face and lateral photos
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The Trial Smile adjustment is a checkpoint for patient and doctor acceptance. At this point, any/all changes must be communicated to the laboratory for best results.

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A Study Model poured from an alginate impression or a digital scan will accurately communicate the changes made to the Trial Smile to Robertson Dental Lab.

9. Final Impressions/Records

Carefully remove the Trial Smile from the mouth and take final impressions of the prepared teeth using SplashMax® Heavy and Light Body 4:30 set or any high-end 4-minute vinyl polisiloxane impression material. You can also choose to e-mail digital scans to info@robertsondentallab.com     

Next use Vanilla Bite® from DenMat or any high-quality bite registration material to provide a bite registration (no wax bites) to the DenMat Lab. 

Now you are ready to submit your case for fabrication of the restorations!

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10. Trial Smile Provisionalization (optional)

If you plan for your patient to wear the Trial Smile while the final lab work is being produced, you can bond the provisionals in place by following these steps:

  • Scrub teeth with chlorhexidine, rinse and dry
  • Polish teeth with DenMat Porcelain Polishing Paste
  • Rinse and dry
  • Spot-etch the teeth by applying Etch ’N’ Seal® for 20 seconds with microbrush using the etching pattern shown
  • Apply a bonding agent such as Tenure® A and B using micro sponge on etched areas
  • Important to dry towards the incisal
  • Apply one coat Tenure® S bond enhancer; dry towards the incisal edge and light cure
  •  Place the Trial Smile (see Step 7)
  • Use interproximal fine diamond (mosquito) to refine the margins along interproximal
  • Use interproximal fine diamond (mosquito) in interproximal margins and facial margins
  • Use football-shaped diamonds on the lingual to finish the incisal wrap and adjust high spots or length.
  • After cleaning up extra flash of composite, polish and apply Gloss-N-Seal and light cure.
 
etching-pattern

Etching pattern to follow

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Shipping Check List

  1. Final VPS Impression: A full arch VPS impression or scan of the prepared teeth
  2. Opposing Impression: A full arch VPS impression or scan of the opposing arch
  3. Study Model: If you made adjustments to the Trial Smile, you must include a study model of the adjusted Trial Smile by following step 8
  4. Wax Up: Original wax-up model, even if you made adjustments to the Trial Smile
  5. Robertson RX Form: Please complete the case submission Lab RX Form and ensuring that all the information is provided. 
Download RX Forms Here
Print Shipping Labels Here
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