‘A good day is when the restoration disappears into the smile’

Dr Alif Moosajee presents a restorative and Zoom tooth whitening case study that harnesses Elab, for a highly accurate and predicable result.

Dr Alif Moosajee’s 32-year-old male patient presented with dissatisfaction with the appearance of his three-part bridge, which spanned his upper right central incisor to upper left lateral incisor.

He also complained that the bridge felt bulky and uncomfortable against his upper lip.

On examination, he exhibited some gum recession, but had no other oral health or medical problems.

During a discussion about replacing the bridge, Dr Moosajee asked the patient if he is happy with the overall colour of his teeth. He suggested the patient might like to consider tooth whitening prior to fitting the new appliance. After creating the new bridge, it is not possible to change the colour of the porcelain.

The patient readily agreed and Dr Moosajee scanned his top and bottom arches with his Itero 5D digital scanner to ensure he could create the most accurate tooth whitening trays.

Dr Moosajee gave the patient Zoom Daywhite and instructions to whiten daily for two weeks.

He went on to advise that because the whitening gel is in a dual barrel, there is no need to mix it. Therefore the patient simply needs to inject a tiny dot into each scallop of the trays. He also advised that the syringes did not need storing in a fridge.

According to Dr Moosajee, his patient was very happy with the outcome of his whitening. He noted that his teeth were several shades lighter and had a healthy lustre.

The patient experienced no sensitivity as a result of the unique presence of amorphous calcium phosphate (ACP) in the Zoom gel formulation.

Dr Moosajee took photographs of the patient’s newly whitened teeth. This enables accurate communication with the practice lab technician, Lino Adolf, to fabricate a bridge that would have the most accurate colour match possible.

The technician used the Elab protocol for this case. This novel digital protocol uses two elements. That way it ensures the best level of communication about the exact colour for the restoration.

Firstly, the lab uses a polarising filter. This reduces the glare that comes from the teeth. So the technician is able to clearly see the character of the tooth and mimic that in their restoration.

Without polarising filter
With polarising filter
Without polarising filter

The other element is the use of a white balance grey reference card.

This is a card that has a known colour temperature. When the technician receives the photograph he is then able to calibrate his image according to that colour temperature. Then he is sure that the colour of the teeth he is viewing on his monitor is exactly the same as the colour of the teeth in the mouth.

It is a beautifully elegant way of conveying the colour and character of the teeth. The standard protocol of using shade tabs is fraught with potential problems. It can often lead to dissatisfaction from clinicians and patients.

In Dr Moosajee’s opinion, the system achieves a new standard for shade management in restorative dentistry.

As the patient’s old bridge was quite short, Dr Moosajee prepared the teeth so that the new crowns would fit closer to the gum line.

He also created a bed in the gingival tissue for the pontic part of the restoration to sit.

Dr Moosajee created an ovate-shaped pontic. This way the bridge would fit neatly into the gum. It creates the illusion of a tooth emanating from the gum, rather than one simply sitting on top of it.

The final restoration was extremely harmonious, fitting comfortably and achieving a highly accurate colour and texture match.

The patient was absolutely delighted with the final outcome. As was Dr Moosajee who concludes: ‘A good day is when the restoration disappears into the smile’.

For more information about the Zoom whitening system in this restorative case, please visit www.philips.co.uk/dentalprofessional.

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