Absolute aesthetics in manufactured ceramic veneers

dd T E C H N I Q U E
Absolute aesthetics in manufactured ceramic veneers
Ceramic Veneers –
Simple to Complex
A c o n t r i b u t i o n f r o m O t t o P r a n d t n e r , M D T, S a l z b u r g / A u s t r i a
Veneers are the most frequently prescribed aesthetic restorations today. In the thirties
Charles Pincus, a dentist in California, gave the go ahead for veneer restorations. They
were already being used by film stars to temporarily change their appearance.
Ceramic veneers can be offered as the treatment option in a wide variety of different
cases such as correcting tooth defects, abrasion, orthodontics, diastema, tooth discoloration, coronal fracture or to adjust occlusion. Before preparing the teeth a complete
analysis should be carried out in order to optimize the result. In this way it can be
ensured that the teeth being veneered will need only minimal preparation, or in some
areas none at all. The teeth being restored with ceramic veneers are prepared between
3 and 30 percent only, whereas in comparison a tooth being prepared for either a full
gold or bonded crown will receive a preparation of between 63 and 72 percent. This is
somewhat invasive.
Indices: Aesthetic, treatment plan, oral anatomy, model, provisionals, veneers
In figure 1 you can see that the reflection on the teeth
is in harmony with the reflection on the gingiva. This
gives both the dental technician and the dentist a
good opportunity to check the emergence profile to
make sure it is the same biotype as the patient. The
gingival topography reflects on to the tooth below and
on the bone architecture. The “wavy“ formation of the
gingiva is determined by the shape of the tooth; the
basic shape of the tooth – round, triangular or square –
further determines the degree of curve in the arched
form of the gingiva.
1
8 dental dialogue UK VOLUME 3 2009 ©
The curved shape of the cervical edge is also categorized by three basic shapes: high, medium or flat.
Oval or square teeth show a less visible curve shape
on the gingiva than triangular teeth (Fig 2).
The labial thickness of the tissue is classified in thin,
normal or thick. On a thin bone and a thin gingiva
for example the emergence profile should be built up
very flat. The classifications of the gingival biotypes
have significant influences on the aesthetic and the
long-term stability of the gingiva.
2
Figs 1 and 2
The reflection on
the teeth is in
harmony with the
reflection on the
gingiva. Oval or
square teeth show
a less visible
curved shape on
the gingiva than
triangular teeth.
T E C H N I Q U E dd
3
Sulcus
0.69 mm
Biologische
Breite
2.04 mm
Ephithel Gewebe
0.97 mm
ZSG
BindegewebsAttachment
1.07 mm
SchmelzZementGrenze
Knochendicke
Relative Weichgewebedicke
Fig 3 The cross section of the
upper third of the tooth-holdingaperture. Biologic width 2.04 mm,
bone thickness, relative soft tissue
thickness
Fig 4
west – Los Angeles Times, July
2006, “The forever Young Issues”
Photo-Illustration by Phillip Toledano
Figure 3 shows the cross section of the upper third
of the tooth-holding-aperture. This area can be subdivided in to three segments: the supra-crestel connective tissue attachment, the epithelia connective tissue
and the sulcus. The fibres of the connective tissue
attachment string from the bone rim to the cementenamel-border (in German: ZSG). The epithelia connective tissue goes from the cementenamel- border to
the tooth sulcus. A study made by Garguilo and Ingber
shows the combined biological width of the epithelia
and the connective tissue is 2.04 mm. This figure
should be taken as a guideline. The dental team has a
big responsibility when dealing with a patient who
presents with healthy dentition requesting veneers
purely for aesthetic improvement.
Who is going to take responsibility in the case of
recession of the gingiva or loss of the papilla? Will it
be the dentist – or perhaps the dental technician?!
Both scenarios are frustrating for the whole team as
right from the start this aspect has to be considered in
the treatment plan. It must be taken into account that
the final result of an extensive treatment could be compromised should the gingiva need correction after the
“aesthetic treatment“ is finalised. This can prove both
time consuming and expensive and often can only be
resolved by a specialist.
There are now techniques that can improve the whole
appearance; the colour, position, shape and size without the need to prepare the teeth. For example – orthodontic treatment can be done using “Invisalign” or by
conventional regulating methods
4
and colour changes can be achieved through bleaching
the teeth either at home or at the surgery. Composite
restorations are often an attractive and inexpensive
alternative as there is no need for the dental technician
to be involved. On the other hand dental technicians
can make “additional veneers” with no need to prepare
the teeth.
As the goal of most patients is to have a younger
appearance, aesthetic dentistry also offers a solution
by restoring teeth to hide the signs of aging.
The smile can be the most striking feature of the face.
This is why the charisma of the patient needs to be in
dento-facial harmony. There are solutions in modern
dentistry that can fulfil the wish for a youthful- harmonic smile and which also offer better function and
oral health at the same time.
The edition “west – Lost Angeles Times” (Fig 4) had
an interesting article titled “The science and sociology
of cheating the clock.” This was about a study carried
out in 2004 by the “American Academy for Cosmetic
Dentistry” which showed that 40 percent of all participating surgeries experienced an increase of 15 percent
in cosmetic dentistry.
In the last five years this figure has since risen to 205
percent (rising rate of Med Spas) – 40 times as much!
The figures from all the USA cosmetic surgeries in
2005 showed that in the age group 35 to 50 the figure
was 47 percent but in the 51 to 64 age group
24 percent.
© VOLUME 3 2009 dental dialogue UK 9
dd T E C H N I Q U E
Fig 5 Status: Not nice. A young female patient with discoloured composite
tooth
Fig 6 Preparation of the tooth
Fig 7 Shade taking after the preparation
Fig 8 Example of a hydrocolloid impression
First patient case
A 19 year old female patient was referred from her
childhood dentist to the surgery of Dr Sheets, Dr
Paquette and Dr Wu after having to repair a broken
tooth horizontally on several occasions (21). It was
unnecessary in this case to use a face/ear bow to
take a centric bite registration, because the starting
situation needed only slight correction (Figs 5 and 6).
The working process is usually the same: photo documentation of the starting situation (Fig 7), condyle referenced mounted study models for the diagnostic waxup, silicone putty of the wax-up, preparation help
(mask) of the wax-up as well as a provisional. After at
least ten days, in which the patient establishes if the
function, aesthetics and phonetics work for her, it is
“judgement day” for the provisional. Close friends, as
well as family, are an influence in the evaluation of the
aesthetics of the new tooth. They should all have an
opinion after ten days. If after ten days everyone is
pleased with the provisionals
10 dental dialogue UK VOLUME 3 2009 ©
an impression will be taken and a master model cast.
This model will be the base for providingthe ceramic
veneer.
Model production:
When casting the master model it is necessary to
take care with the preparation and also to pay attention
to the following points:
- mesial papilla
- distal papilla
- gingival height
- gingival shape
- bone contour
- surface of the gingiva
The result of the ready made restoration is highly
influenced by these information points.
About the provisional:
The provisional is made extra-orally on a model. For
the impression of the prepared teeth a hydro alginate
is needed and for the other teeth an ordinary alginate
(Fig 8).
T E C H N I Q U E dd
Fig 9 Pressed basic acrylic crown before the cut-back.
At this stage the colour can be evaluated.
Fig 10 Example of a cut-back. Above are the appropriate
colours for internal staining.
Fig 11 The ready-made provisional veneer on a solid model.
Fig 12 The individual provisional three weeks after fitting
The advantage of this kind of impression is that there
is no need to place retraction cords. The alginate
speeds up the process of manufacturing the provisional because using a mounting plaster with a higher
water ratio, mixed for 20 seconds under vacuum,
results in shorter setting time.
The alginate can then be separated from the model
without worrying about damaging the cast. The provisional was pressed using the silicone mould taken
from the wax-up (Fig 9).
The basic crown should then be cut-back (Fig 10) and
stain applied in this case using Gradia colour and then
finished with a layer of opalising transparent material
“TI“ also from Gradia (Fig 11).
When pressing and using the cut-back-technique use
acrylic that is one shade lighter.
The advantages in using a PMMA based acrylic such
as New Outline or Jet Acrylic is that it makes the
handling easier for the indirect veneer method,
although nowadays these PMMA based acrylics are
considered to be of a past generation. However in
comparison with a “bite acrylic” cartridge dispensed
material, PMMA does have the advantage of being less
brittle.
There is much less likelihood of a crown that is less
brittle being damaged when lifting after cementing.
The higher development of heat (exothermic bonding
reaction) and the higher monomer content of PMMA is
not relevant, because the provisionals are indirectly
produced.
However, on the other hand an advantage of the new
generation of bite-acrylics is the fluorescent characterisation – natural teeth can be copied better. When
using the cut-back-technique the labial surface is built
up thinly with a fluorescing and an opalescing acrylic.
In this way the restoration can achieve much higher
quality (Fig 12).
Result:
A good provisional is the best advertising for the
whole treatment team.
© VOLUME 3 2009 dental dialogue UK 11
dd
13
15
14
16
Fig 13
A master model
(Geller model)
giving good gingival information
and a silicone
matrix made from
the model of the
original situation
are elementary
requirements for
a good result.
Fig 14
Here we see how
the prep is lengthened using
opaque dentine
with the dentine
build-up of the
labial visible.
This layer ends
roughly 1 mm
from the border of
the preparation.
Fig 15
The ready made
Feldspat-ceramicveneer on the
master model.
17
Fig 16
The characteristics of the youthful
patient have been
adopted, e.g. the
perykimata are
clearly visible.
Fig 17
The veneer three
month after fitting
Layering the ceramic:
- To begin with the horizontal fracture is lengthened
with opaque dentin.
- Secondly the labial surface is layered thinly with
dentin, to approximately 1 mm below the preparation
border.
- After that, using a 1:1 mixture of dentin and proximal-dentin, the inter dental areas are closed. In the
cervical area the preparation border is slightly over
laid with a 1:1 mixture of enamel and dentin.
Therefore a better chameleon effect is achieved.
- The fourth step makes up the application of the
mamelons and enamel depending on the individual
patient.
12 dental dialogue UK VOLUME 3 2009 ©
All these steps are controlled at all times with the
silicone key. The advantage of the layering technique,
compared with pressing, is the thinness of the veneer –
added to which, it is possible to built up with different
opacities – whatever the demands of the tooth
(Figs 13 to 16).
After three months the ready-made veneer fits harmoniously into the oral surroundings (Fig 17). The harmony between light, colour, opalescence, translucence, shape, surface texture and glaze is clearly
visible.
dd
Fig 18
Portrait shot of the
new patient at the
first meeting
Fig 19
Close-up of the
starting situation
18
19
20
21
22
23
Fig 20
This is the guide line for the upper
central which
I developed:
The height of the
lower lip is the
same as the width
of the central on
the upper.
Fig 21
Provisional interdental closure
guide with composite. The incisal
edge has been
corrected with a
black marker.
Fig 22
Take note of the
preparation in the
papilla area.
Fig 23
Individual provisionals made from
the wax-up
Second patient case
The second case was a 29 year old patient (Fig 18)
who was unhappy about the gaps between his teeth
(Figs 19 and 20). He told us that he was the butt of
jokes at school.
The aesthetic treatment steps began with bleaching
and also a diagnostic wax-up, which was demons trated to the patient in one session.
At the same session a try in of a mock-up was done;
this is called “Hollywood Stent”. This mock-up can
only be manufactured with the wax-up (Fig 21).
After this the preparation of the veneer was done and
the provisionals were produced using the cutbacktechnique that was previously described (Figs 22 and
23).
After the patient has worn the provisional for a couple
of weeks the dentist and the patient evaluate the aesthetics and providing everyone is satisfied an impression is taken of the situation. The impression of the
situation of the provisional is not taken on the
same day as the impression of the preparation because
the gingeval information would not be sufficiently
precise. If one maintains this protocol there should be
no negative surprises on the day the ceramic veneer is
fitted (Figs 24 to 31).
The patient had asked for us to close his diasthema and
shorten the centrals. For this reason flowable composite was used interdentally for demonstration purposes
(Fig 21). To “arrange” the incisal edge a black marker
was used. Nothing was changed labialy.
This first aesthetic prediction is very helpful for the
patient and also for the whole treatment team.
The only difference of mock-ups manufactured orally
or extra orally is that the silicone matrix is taken either
from the mouth or from the model. In this case it
wasn’t possible to manufacture an extra-oral mock-up
because the teeth had been neither lengthened nor labialy changed. When preparing teeth with diasthemas it
is important to take extra care interdentally, because
the existing emergence profile is changed primarily in
the interdental area.
© VOLUME 3 2009 dental dialogue UK 13
dd
Fig 24 Geller model with silicone gingival mask. Take
notice of the moisture channels in the inter dental area
Fig 25 The ready-made and very thin veneers on a mirror. Cervical 0.5
mm ,labial 0.8 mm
Fig 26 The veneers in situ – two months after fitting
Key dental elements for enhancing an image and/or
reproducing the natural look:
- Analysis of the “oral-facial aesthetic”
- Understandable diagnosis and treatment plan
- Creation of a subject treatment protocol: dentist,
dental technician, periodontologist, orthodontist
etc.
- Re-confirmation of the goals during the treatment
course
- Choice of the most conservative treatment for
functional and aesthetic goals
- Establishing a real expectation for the patient
14 dental dialogue UK VOLUME 3 2009 ©
Fig 27
This result could
only have been
achieved by
specifically
working together.
The patient is very
happy.
dd
Fig 28 The biological tooth width in detail before…
Fig 29 … and after the preparation
Fig 30 The changed emergence profile interdentally is clearly visible when the definitive veneer restoration is done.
Fig 31
A “Japanese
trick*” is used here
in order to represent
an imitation of
a surface crack.
A very pointed
bur, which doesn’t
rotate is used for
this and is pulled
along the crown in
the same direction
as the line angle of
the tooth. The
result is shown on
the tooth 11
in figure 30.
*Hiroki Goto
** unwanted ceramic “flags” can prevent good fit and could cause ceramic
parts to break off.
Quality control necessary to achieve
red-white aesthetic results:
- Analysis of the biotype
- Adequate preparation depending on expectation
and indication
- Impressions should be free of air bubbles, other
faults, blood and salvia
- Proper fitting provisional and therapeutic design
of the provisional
- Microscopic fit of the restoration**
- Design of the restoration with respect to the
emergence profile
- Shape of the restoration, which needs to fit to the
biotype of the patient (see Figs 1 and 2)
- Perfect fixation of the restoration
- Design of the restoration using biodynamicguidlines
© VOLUME 3 2009 dental dialogue UK 15
Fig 32
The old bridge
with the mesial
pontic (tooth 22)*
dd
32
34
36
33
35
37
Third patient case
Case history:
The patient introduced here is a 58 year old woman,
who was unhappy with the aesthetics and the function
of her fifteen year old restoration.
Diagnosis:
Badly fitting crown edges. Figure 32 shows tissue
recession at tooth 21 as well as a restoration class 5.
The bone crest has sunk in the area of 22. About 91
percent of all anterior extractions cause significant
bone crest defects [1].
The front teeth on the upper and lower are jaw slightly rotated. A temporal mandibular dysfunction has also
been diagnosed. The x-ray status in figure 33 shows
the situation before the periodontal treatment.
Treatment plan:
We begin with periodontal treatment and the resumption of existing root canal treatment. A regulation
on the lower jaw followed by an appliance therapy.
Then
a
soft
and
hard
tissue
growth
16 dental dialogue UK VOLUME 3 2009 ©
arrangement of an ovate-pontic is carried out. After
the preparation the upper and lower teeth are been
bleached.
In figure 34 it is clear in the preparation that there are
differences visible between the anterior crowns, the
canines and the veneer. Therefore an adjustment has to
be done that adapts the shape and colour of the veneer
to the crowns. Tooth 12 is root treated and discoloured
in the root area. Also an old, too deep preparation is
visible. The crown rim has been built up with opaque
and fluorescent material, so that the discolouration
does not have a negative influence on the restoration
(Fig 36). Figure 35 gives
* We would like to apologize about the quality of the
image. This image is a few years old and there is no
original available and therefore a printed image had to
be scanned.
** If a “desensitiser” (Gluma) is used after the preparation the contrast within the tooth is stronger and the
statement of the photo is more powerful.
Fig 34
A shot one must
not miss of the
preparation**.
If shade taking is
not done at this
stage of the
preparation the
quality of the
restoration will
not be appropriately manufactured.
Fig 35
Model with different preparation
designs
Fig 36
If the prepared
teeth are very
discoloured the
cervical area is
evenly opened
(arrow) and
closed up again
with orange
mamelon
material.The
negative representation was
chosen to make
the gap visible.
Fig 37
Arestin is a mino
cycline hydro
chloride, which
kills bacteria
connected with
periodontal ill nesses.
dd
Figs 38 and 39 Lateral views of the restoration: tooth 31 is a ceramic veneer, 12 is a bonded ceramic crown, 11 is a
ceramic veneer and 21 to 23 have been restored with a bonded ceramic bridge.
Fig 40 Complete front tooth restoration one year after fitting.
Fig 41
We were
able to give
the patient an
attractive
smile.
an overall view of the completed situation. Figure 37
shows Arestin. It kills the bacteria that connected to periodontal diseases. This was used especially for the care of
the periodontium on tooth 12 after a hygienic treatment.
Please take note of the veneer-onlay preparation in the
premolar area in figure 35. In this special case we decided for a bridge with an ovate-pontic, because the starting
situation (Figs 32 and 33) would not have allowed an
implant based aesthetic solution. Ovate pontics give
much better aesthetics and function compared with other
pontic designs (Figs 38 to 41) [1].
© VOLUME 3 2009 dental dialogue UK 17
dd T E C H N I Q U E
Figs 42 and 43
The starting
situation is shown
here. Please take
note how the
patient tries to
conceal the defect
with the upper lip.
42
43
Fig 44
This picture
shows a less than
ideal position of
the implant and
the tooth enamel
border of the tooth
22 is open.
44
45
Fourth patient case
Case history:
This patient had a skateboard accident as a teenager
on which the tooth 21 has been traumatised strongly
and later lost. The implant was placed at the time when
the bone was still at growing stage. This resulted in
disastrous consequences, which stopped the growing
process in the area of the implant. In 1998 the implant
had to be replaced due to a sinus perforation.
The patient was referred to the surgery of Dr Sheets
and Dr Paquette, because she was very unhappy with
the situation.
Looking closely at figure 42, it is easy to see that the
patient has started to get used to a certain habit in order
to conceal the defect through miming (Fig 43). It was
suggested to the patient to have surgical treatment to
correct the hanging lips.
Diagnosis:
- Tooth 11 was restored with a non-aesthetic veneer;
mesial recession.
- The implant in the area 21 is stable; the position
however is rather insufficient.
- Tooth 22 shows a strong recession mesially, about
6 mm.
- The central line and the tooth angle deviate about
3 to 4 mm (compare figures 42 and 43).
- The patient is very emotional as this shape was
caused through an accident.
18 dental dialogue UK VOLUME 3 2009 ©
Fig 45
After the preparation different
coloured stumps
are visible.
Fig 46
The old restoration was clearly
difficult to keep
clean.
46
Treatment plan:
- Manufacture diagnostic wax-up
- Remove the old veneer on tooth 11
- Veneer preparation on teeth 12 and 22
- Impression of the implant position
- Manufacture of a long-term provisional using the
diagnostic wax-up as a guide
- Evaluation of the provisional
- Manufacture of the finished restoration
- Treatment with an intra-veinal anaesthetic
In figure 44 the cement-enamel-border of tooth 22 is
visible. If one ads 1.56 mm to this border (see figure 3)
it would give the physiological course of the gingiva.
On top of the strong atrophy in the area 21 there was
also a strong discolouration of tooth 11 (Fig 45). It was
also very clear to see that the old restoration was
difficult to clean (Fig 46).
T E C H N I Q U E dd
Fig 47
Schematic
representation
of the veneer of
tooth 22.
The pink gingival
ceramic closed
directly with the
natural tissue.
This way the
recession is concealed and the
tooth gets an ideal
proportion.
47
Fig 48
On the build up feldspat-ceramic veneer the translucency
of the different materials is clearly visible, because of the
black background. The ceramic gingiva shows a higher
opacity.
Fig 49 The implant crown with “pink tissue” visualises the
Fig 50 This photo has been taken straight after the final fit.
Product list
Indication
Name
Manufacturer/Trade
Fire resistant die material
Cosmotech Vest
GC UK
Plaster
Fuji Rock
GC UK
Ceramic furnace
Austromat M
Dekema
Metal for the bonded bridge
Overture
Jensen
Acrylic for the provisional
Gradia
GC UK
Ceramic material
Creation Surprise
Creation Willi Geller/
Amann Girrbach
in Case 1, 2 and 4
Ceramic material in Case 3
IPS d.Sign
Ivoclar Vivadent
48
Conditions are not always ideal. However in cases
like this it is important to generate a clinical and
aesthetically acceptable result.
The following documented case demonstrates a
method showing how the level of the gingiva on
veneer cases can be raised optically in the area of a
defect by using pink ceramic (Figs 47 to 50).
After the final fit of this unusual veneer restoration
the patient had appointments in short intervals in
order to check the cleaning ability of the restoration.
It turned out that in comparison to the old restoration
(Fig 51) the interdental cleaning of the new
ceramic restoration (Fig 52) was considerably easier
to handle.
© VOLUME 3 2009 dental dialogue UK 19
dd
Fig 51
The situation
before the
treatment
Fig 52
The new restoration
four months after
fitting. Please take
note how the
gingiva of the
veneer on 22
integrates
Gratitude
I would like to thank Dr Cherilyn Sheets very much
for her cooperation working on patient cases 2, 3
and 4, also Dr Jean Wu for working together on
patient case 1 as well as Dr Peter Nordland who was
responsible for the augmentation on patient case 3.
This contribution would not have been possible without working cooperation with each other’s specialities
and the knowledge exchange of Dr Cherilyn Sheets,
Jacinthe Paquette, Dr Jean Wu and Dr Peter Nordland.
Therefore every patient experience is a positive
memory. The philosophy of the team is based on the
conviction that nothing is impossible.
20 dental dialogue UK VOLUME 3 2009 ©
Fig 53
The finished
smile.
The corrected
midline is nice
to see here.
T E C H N I Q U E dd
Literature
[1] Abrams HL, Dralle PW, Wallick MM: Incidence of anterior ridge deformi ties in partially
edentulous patients. J Prosthet Dent, 1987 Feb; 57(2):191-4.
[2] Prandtner O, Partial Anadontia: dental dialogue, 5/2007, 88-99.
[3] Sheets CG, Taniguchi T: A multidie technique for the fabrication of porcelain laminate
veneers. J Prosthet Dent, 1993 Oct; 70(4): 291-5.
[4] Edelhoff D, Sorensen JA: Tooth structure removal associated with various preparation
designs for anterior teeth. J Prosthet Dent, 2002 May; 87(5): 503-9.
[5] Gu.rel G: Porcelain laminate veneers: minimal tooth preparation by design.
Dent Clin North Am, 2007 Apr; 51(2): 419-31.
[6] Gu.rel G, Bichacho N: Permanent diagnostic provisional restorations for predictable
results when redesigning the smile. Pract Proced Aesthet Dent, 2006 Jun;18(5): 281-6;
quiz 288, 316-7.
[7] Davis BK: Dental aesthetics and the aging patient. British Dental Journal (2005); 199,
195-202. doi: 10.1038/sj. bdj. 4812611.
[8] IAhmad1: Anterior dental aesthetics: Gingival perspective. J Esthet Restor Dent. 2004;16
(1): 7-16; discussion 17-8 15259539.
[9] Magne, Pascal; Belser, Urs: Bonded Porcelain Restorations in the Anterior
Dentition: A Biomimetic Approach.
[10] Romano, Rafi: The Art of the Smile: Integrating Prosthodontics, Orthodontics,
Periodontics, Dental Technology, and Plastic Surgery in Esthetic Dental Treatment.
[11] Chiche, Gerard J. and Aoshima, Hitoshi: Smile Design: A Guide for Clinician,
Ceramist, and Patient.
[12] Kamalakidis S, Paniz G, Kang KH, Hirayama H: Nonsurgical management of soft tissue
deficiencies for anterior single implant-supported restorations: a clinical report. J Prosthet
Dent, 2007 Jan; 97(1):1-5.
About the author
His focus on quality and the
aesthetic, combined with a recommendation from Willi Geller,
lead Otto Prandtner in 2002 to
the surgery of Dr Sheets &
Paquette in Newport Beach. It
is recognised as one of the
best dental surgeries in the
USA. Otto Prandtner worked
there as laboratory manager of an international
team of six people. Before he moved to California
he was working for Peter Biekert in Stuttgart. Even
there he was working intensively with patients and
gave hands-on courses.
Born in Austria he was first educated with Creation
Ceramic by an Oral Design member in Salzburg. In
addition to his entrance in lecture work in 2004 he
also gives courses at the Newport Coast Oral Facial
Institute and for Amann Girrbach**.
Otto Prandtner gives thanks to Michel and Pascal
Magne for recommending him to give a hands-on
course on “Anterior Implant Aesthetics” at the
IDEA*** in San Francisco in 2009. Otto Prandtner
lives and works ind Munich, Germany.
Contact address: Ztm. Otto Prandtner
prandtner.creative@me.com
**www.amanngirrbach.de, ***www.ideausa.net
OTTOPRANDTNER,
PRANDTNER,M.D.T.
M.D.T.
OTTO
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toto
interact
with
the
instructor
and
get
clear
mentoring
and
guidelines
onon
your
specific
questions.
Key
focus
this
course:
Key
focus
ofof
this
course:
How
receive
and
use
clinically
relevant
information
that
needed
provide
successful
advanced
x How
toto
receive
and
use
clinically
relevant
information
that
is is
needed
toto
provide
successful
advanced
techniques
the
creation
esthetic
and
functional
implant
and
crown
restorations
techniques
forfor
the
creation
ofof
esthetic
and
functional
implant
and
crown
restorations
The
fabrication
two
maxillary
central
incisors
- number
eight
will
a crown
preparation
and
number
x The
fabrication
ofof
two
maxillary
central
incisors
- number
eight
will
bebe
a crown
preparation
and
number
nine
will
implant
restoration
nine
will
bebe
anan
implant
restoration
Key
elements
covered:
Key
elements
covered:
Create
and
analyze
the
emergence
profile
the
emergence
profile
x Create
and
analyze
x
Design
a wax-up
that
will
serve
a diagnostic
esthetic
guide
Design a wax-up
that
will
serve
asas
a diagnostic
esthetic
guide
Customize
abutments
with
tooth-specific
contours
site-specific
needs
x Customize
abutments
with
tooth-specific
contours
forfor
site-specific
needs
x
Shape
surface
texture
and
luster
to
match
surrounding
dentition
Shape surface texture and luster to match surrounding dentition
Consider
what
needed
create
a surgical
guide
x Consider
what
is is
needed
to to
create
a surgical
guide
Discover
a new
world
dental
education.
IDEA.
Discover
a new
world
ofof
dental
education.
IDEA.
Key
addition:
Key
addition:
You
are
encouraged
bring
challenging
interesting
cases
discuss
with
the
instructor
and
possible
sharing
You
are
encouraged
toto
bring
challenging
oror
interesting
cases
toto
discuss
with
the
instructor
and
possible
sharing
with
the
entire
class.
with
the
entire
class.
Testimonials:
Testimonials:
This
course
was
very
educative.
I can
now
create
custom
abutments
based
scientific
approach;
the
results
This
course
was
very
educative.
I can
now
create
custom
abutments
based
onon
aa
scientific
approach;
the
results
will
more
predictable.
I will
return
my
with
more
self
confidence.
will
bebe
more
predictable.
I will
return
toto
my
lablab
with
more
self
confidence.
Sandra
Sundance,
Minneapolis,
Sandra
Sundance,
Minneapolis,
MIMI
goal
was
extend
my
knowledge
implant
dentistry.
Otto
Prandtner
exceeded
my
expectations.
I could
MyMy
goal
was
toto
extend
my
knowledge
in in
implant
dentistry.
Otto
Prandtner
exceeded
my
expectations.
I could
upgrade
my
understanding
implant
restorations
tremendously.
The
IDEA
facility,
cutting
edge
and
the
upgrade
my
understanding
forfor
implant
restorations
tremendously.
The
IDEA
facility,
itsits
cutting
edge
lablab
and
the
staff
are
certainly
the
leader
continuing
dental
education.”
staff
are
certainly
the
leader
in in
continuing
dental
education.”
William
Stackert,
Santa
Rosa,
CA
William
Stackert,
Santa
Rosa,
CA
ours
pac
kage
CC
ours
e epac
kage
$ 2,180
without
hotel
$ 2,180
without
hotel
$ 2,480
with
hotel
$ 2,480
with
hotel
© VOLUME 3 2009 dental dialogue UK 21