[图文]一例前牙瓷贴面病例的讨论

一楼Lewis Sharp CDTPosted: 4/15/2007 1:56:25 PM  

Introduction: The front office manager for my busiest client wanted to have veneers done on her 6 maxilary anteriors. Future treatement will also include veneers for her lower 6 anteriors. As has been discussed on other threads on DT there is tremendous pressure to get it right. She definitely uses her new smile to help persuade patients to consider similar treatment.

简要：我的前台经理想做她的六颗上前牙贴面。未来的下前六颗牙也打算做。。。。无疑她会用她的新的笑容吸引患者考虑做与她类似的治疗。

Patient was un-happy with spaces and discoloration of existing teeth.

患者主诉希望改善前牙的间隙和变色。

She also has very limited mobility in her upper lip. We wanted to try to show a little more incisal edge ~3mm or so and "feminize" her smile a bit.

她的上唇动度非常有限。我们希望尝试使得她的切缘暴露更多一点～3mm左右，并且使得她的微笑更女性化一些。

This photo shows the extent of mobility in her upper lip.

这张照片显示出她上唇动度的极限。

Completed wax-up. We deicided to do a veneer on #5 as well. #12 had recentley been crowned with a Lava crown. The doctor used the wax-up as a stent（译者怀疑这里有笔误） for the temps.....sorry I don't have any photos of the temps.

完成的蜡牙。我们设计5号牙（14）也制作贴面。12号牙（24）最近刚做了一个LAVA全瓷冠。经治医生采用术前蜡牙制作临时贴面，抱歉我没有临时贴面的照片。

Close up of wax-up.

蜡牙的近观

 

Photo of veneer preps.

贴面预备的照片

Completed veneers.

完成的瓷贴面

 

Smile shot.

微笑照片

 

Lip at rest.

唇休息位照片

 

Conclusion:

She was thrilled with the results. She shows just about everyone that comes in the door her new smile!!

结论：看到结果她很兴奋。她向每个走进来的人“秀”她的新微笑！

 

二楼brelo2 Posted: 4/20/2007 8:53:40 PM  

frankly, #7 and #10 do not look similar.   your probably 1 mm shorter on #10 as you should be and the incisal edge of these teeth are not similar, with #7 being nice and flat, and #10 being way too round.

glad i am not your office manager

坦白的讲，12和22看起来不太像。22应该再短1mm，这两颗牙切缘不太像，12看起来自然平滑，但是22看起来太圆钝了。

 

三楼shizont Posted: 4/20/2007 9:16:25 PM  

The veneers look very nice and life-like.  8 & 9 should be symetrical, 7 & 10 should never be.  At least that is ONE theory of esthetics.  so I'm not agreeing with the second post  regarding 7 & 10

Hows her labial frenum?  Might you get  a higher smile line with a frenectomy?

You might have tried enamoplasty alone first.  Just rounding the corners might have produced as much feminization with less loss of tooth structure.  Getting a higher smile line would do more to feminize her smile.

Just my opinion.  THe teeth are already prepped but the frenectomy remains an option to show off more of that nice porcelain.

贴面很生动逼真。11，21应该对称，12，22最好不要对称。至少这是美学的一个基本观点。所以我不同意二楼关于12，22的意见。

不知患者的唇系带怎么样？如果做一个系带修整术可能会使患者的笑线更高些。

开始可以只做釉质修整。圆滑线角可能既可以产生更多“女性化”感觉又可以少磨牙。将笑线抬高可以产生更好的女性化效果。

仅仅是我的个人看法。牙齿已经预备好，但是系带修整术仍可以是一个展示更好瓷效果的一个选择

 

四楼doctored Posted: 4/20/2007 9:29:38 PM  

I give the case 2 thumbs up!!  Looks real. Ed

太逼真了！ED

 

五楼Tarun "T-Bone" Agarwal Posted: 4/21/2007 4:53:22 AM  

lewis the restorations look very nice...  does this dentist participate here?

i have some questions and thoughts on the rationale for the lingual margin design of the preparations?

Tarun

效果很好！这个牙医也来我们论坛么？

我想问几个关于贴面预备中舌侧边缘设计的理论问题？

 

六楼ricky-ticky-tavy Posted: 4/21/2007 5:45:28 AM  

I like the case you posted.  They look very natural and not at all like veneers.  If she is happy then your job was successful

我喜欢你发的这个病例。它们看起来很自然，不像贴面。

 

七楼JaimePosted: 4/21/2007 5:59:07 AM  

Nice case Dr., the differences between laterals actually make it look natural and beautiful...I might have taken the preparation in 9 a little more gingival.  Also, congrats to your ceramist, the porcelains looks very nice, not just plain white (I´m seeing more and more of this everyday)  Congrats

很好的病例！两颗侧切牙之间的差异恰恰使得整体看起来自然逼真！我可能会把21牙体预备更龈方一些。恭喜你的技师，这些瓷修复体太完美了！

 

八楼Rick Knecht CDTPosted: 4/21/2007 6:48:39 AM  

Lewis,Nice job. were these pressed or refractory.

Rick

很好的病例！是铸压的还是烤瓷的？

九楼Lewis Sharp CDTPosted: 4/21/2007 11:09:58 AM  

I'm enjoying the comments.  It's always interesting to get so many different philosophies and tastes on these types of cases.   I posted this case last Sunday and thought that maybe I would skate on by without any comments.

I will address a couple of the replies made so far.  This patient had bleached, but didn't want the "American Standard" white type veneers.  We discussed the shade and also breaking up the shade with slightly lighter laterals and darker canines.  She wanted them to look natural.  I especially enjoy doing these types of cases because they do reflect a more natural look......but I've also found that not all patients like it.  It seems that some want to make sure that people know that they've paid good money to have their smile made over, and that's cool, they are the ones writing out the check. 

I follow Spears philosophy on anterior tooth arrangement.  It's important to get #8 & 9 symmetrical and establish length and tooth display.   The "Golden Proportion" rule isn't even that critical, based on studies that he cites.

As far as a possible frenectomy, that may be something to look into.

Tarun, the doctor does not participate here, I'm trying to get him to.  I would be happy to pass on any comments you might have......

Rick,  these are Authentic pressed veneers.

很高兴看到大家的意见。在这样的病例讨论中能获得这么多的不同看法和喜好很有趣。上周六我贴出这个病例以为大家不会给出很多看法。

我会记下回复。这个患者已经漂白过，但是不想要“美国标准”那么白的贴面。我们讨论了色度但是侧切牙的色度浅些，尖牙的深点。她想让它们看起来更自然。我特别喜欢做这种病例因为它们确实可以塑造一个更自然的外观。但我也发现并不是所有的患者都喜欢。有些人想要别人知道他们花了大价钱使他们的微笑改头换面，那很酷！

在前牙排列方面我遵循Spear的原则，对于11，21获得对称，重建牙齿长度和外观很重要。基于他引用的研究结果，“黄金”比例不要太严格。

只要可能做系带修整，。。。。。。。

Tarun，那位医生并不来论坛，我正试着让她来。我很高兴传达你的任何评论给她。

Rick，这是Authentic铸瓷。（详见http://www.jensenindustries.com/authentic/index.htm）

 

 十楼eeznogoodPosted: 4/24/2007 8:58:23 AM  

This work is top notch!! Congrats to both lab and dentist.  Il ove everything about it.

The dentist's choice of prepping the lingual could've been avoided in my opinion. I believe this is what Tarun is trying to say. The lingual prepp is too shallow and the porcelain covering this area will be propne to fracture. It would've been better to have a flat incisal edge. Good bond to ennamel is ennough for retention.

Great Job to all. Thxs for posting this case.

（第二段）在我看来舌侧预备的选择应该尽可能避免。我想那也是Tarun想说的。这个病历中舌侧预备太浅，覆盖瓷层的区域容易折裂。还不如备一个平坦的切缘（对接式）。对牙釉质的粘接力足够了。

十一楼drevsPosted: 4/24/2007 9:50:37 PM  

Did the doc or patient object to the wax up?  I find the contours on the waxup much more appealing than the final product.

医生或者患者对蜡牙有过异议么？我发现蜡牙的外形比最终的瓷贴面更富于表现力。

 

十二楼Lewis Sharp CDTPosted: 4/26/2007 7:00:29 AM  

I don't have any photos of the temps.....they were done from the wax-up.  Some slight changes were made in the temps and then taken to the ceramics.

我没有临时贴面的照片，他们是根据蜡牙制作的。在临时贴面与制作到瓷贴面的过程中有轻微的改动。

 

十三楼ut-billPosted: 5/1/2007 12:52:10 PM  

Tarun,

         For sake of discussion and so that we may learn what not to do, what are you referring to with the lingual margin design of the preparations?

                           thanks,

                                  Bill K

Tarun：因为是讨论，所以我们想知道什么不能做。你更喜欢什么炎的舌侧牙体预备设计？

十四楼Tarun "T-Bone" AgarwalPosted: 5/1/2007 6:26:03 PM  

this case looks to have a lingual wrap - i dont' have the benefit of having the models so i can't say for certain, but it looks that way----

i feel the best margin for anterior veneers is the lingual butt margin.. it is the strongest and doesn't leave a thin shell of porcelain that may break or intefere with seating...

hope this helps

tarun

这个病例看起来有舌侧半包切缘。我没有看模型，所以还不太肯定，但是看起来确实是那样的。

对于前牙贴面来说，我想最好的边缘是舌侧对接边缘。它是最牢固的，不会有薄的瓷片可能碎掉或者干扰就位。

希望能有帮助

十五偻ut-billPosted: 5/2/2007 12:47:49 PM  

Tarun,

      That does help.  I guess in my mind (only half-functioning)  it seems that if the lower teeth protrude that the veneer may pop off with no lingual prep.  Is the bond strong enough for this not to occur?  I was also reading one of bill strupps old veneer forums and he also places the shoulder as you do and for the same reasons.  He also always breaks interproximal contacts as well, do you do this too?

Tarun:

确实有帮助。在我的思维里（仅在半功能条件下）看起来好像如果下牙前伸，如果没有舌侧预备，贴面可能会掉。对接情况下粘接力够么？我以前读过一本老的贴面专刊，里面医生对于肩台的做法和你一样，也是同样的解释。他也要把牙齿邻面打开，你也这么做么？

十六楼Dr. MacPosted: 5/3/2007 10:49:05 AM  

Nice job, as they definitely look like natural  teeth, rather than chicklets. However, i dont like the laterals, either. They just look too short(in comparison to centrals), and too rounded for my taste.....but as long as the patient is happy, you hit a homerun

看起来确实很自然，而不是竹帘子。然而，我也不喜欢那两颗侧切牙。他们看起来太短了（与中切牙的比例相比），按我的理解，也太圆钝了。但是只要患者高兴，你就击中了本垒打！

 

十七楼danmelkerPosted: 5/3/2007 7:39:23 PM  

Oh Periodontist am I. Great incisal result! I probably would have recommended a little sugical procedure to create symmetry between 7 and 10 not to mention a touch on 8 and 9 to create a better zenith. tissue shaping would have given a little more pleasant appearance. Nice result as I said related to incisal appearance.

我是牙周医生。切缘效果很好！我可能会建议做一个小小的外科处理使得12和22的龈缘顶点能够对称，当然不能涉及到11和12。组织塑形会让结果更令人愉悦。切缘效果确实好。

 

十八楼Lewis Sharp CDTPosted: 5/6/2007 2:34:28 PM  

Dan,

I agree, I think that some tissue shaping would have helped to finish off the case.

Dan:我同意如果做一些组织修整，效果会更好。

十九楼ut-billPosted: 5/10/2007 11:47:44 AM  

Dan,

            What kind of procedure if any could be done to raise her smile line?  And is this in a periodontists arsenal or would a plastic surgeon perform it?

Dan,为了抬高患者笑线能有什么可以做呢？牙周医生和外科医生可以做么？

二十楼Dr. Mac Posted: 5/10/2007 12:28:53 PM  

Quote: (ut-bill)

Dan,

            What kind of procedure if any could be done to raise her smile line?  And is this in a periodontists arsenal or would a plastic surgeon perform it?

I cant remember what its called, but one of our periodontists does this procedure... The results are amazing. Dr. Michael Skinner in.

我记不起来叫什么了，但是我们的牙周医生做过这步。结果棒极了！是nashville的麦克尔医生做得。