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Masterpiece – Visualisation with Precision: The Aesthetic Articulator

QDT featured Yugo’s article in 2016 (originally published in Japanese).   Having trained as a dental technician in Japan (at Osaka University Dental Hospital), being featured in the ‘masterpiece’ section of QDT is an honourable achievement. It is a privileged benchmark that the high-end ceramists in Japan aspire for recognition and respect within the field.   The actual storyline of the article is very similar to my previous post presenting the Aesthetic Articulator (https://smilevirtuoso.com/the-aesthetic-articulator-australian-patent-au2013100527/). However, the aesthetics of the presented case/restorations are probably the best I have ever presented from a technical perspective. The patient desired the highest level/degree of incisal translucency/characteristics, which mimics the complex nature of natural dentition. The outcome is so satisfying that even dental professionals cannot distinguish them from natural teeth.   When I design...

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Before and After 2020: Missing Tooth Replacement on Lateral Incisors (Part 2)

A Caucasian male patient in his youth was introduced to me upon a failure of the previous Maryland-Bridges on 13-11, 21-23. The restorations only lasted for a few months (done by another technician), and I couldn’t identify its cause or never given a specific reason by the treating clinician.   In part 1 of the ‘missing tooth replacement’ (click here to read), I presented implant restorations in Zirconia with Ti interface abutment to replace the lateral incisors. For this case, I present more of a conservative and cost-effective option – Maryland-Bridges in lithium disilicate (e.max) for optimum bonding strength.   Figs 1-2 show the pre-op condition.   Fig 3 shows my standard protocol in shade taking. I make sure to use three different shade guides to identify the...

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Before and After 2019: Missing Tooth Replacement on Lateral Incisors (Part 1)

A Caucasian female patient in her 20s was introduced to me upon completion of extensive orthodontic treatment to create enough space to replace the missing laterals. It has been a long journey for the patient to get to the point having the implants on the laterals and hoping to achieve the smile that she never thought was possible.   There were a few technical challenges that I encountered: the angulation of the screw channels colour matching with the surrounding natural dentition.   1: Today, close to 100% of my implant restorations are requested as screw-retained rather than cement-retained. When the angulation of the implants are not ideal, then my primary choice is to use dynamic abutment – an alternative to the genuine Ti interface...

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Before and After 2018: Smile Makeover – Replacement of Existing Restorations

A Caucasian female patient in her 40s flew in from Switzerland and stayed in Sydney, Australia, over the Xmas break for the smile makeover. Her existing veneers were only done 4-5 years ago by another technician, and she was unhappy with them due to being over contoured.   The treating clinician modified the shape clinically before sending the patient to my studio for a smile design consultation. Thus, her condition was close to ideal, and she was happy with them in general. My job was to identify where we can improve and determine the number of units required to achieve the best possible outcome.   Figs 1-3 show the pre-op condition.   Upon detailed discussion, I observed the following information.   Shape: As noted above, the treating clinician improved...

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Before and After 2017: Smile Makeover – Achieving Super-bright Life-like Restorations

A Caucasian female patient in her 30s visited me for a consultation with temporary restorations in the mouth. She had her first set of veneers, which was about 16 years old. She recently had Invisalign, but the teeth moved out of the alignment. She is also concerned about the root exposure and uneven gingival level.   She had missing second premolars and wished to have a brighter smile, in fact, as bright as possible without making them look artificial. She commenced bleaching on her lower dentition to reduce the contrast. We decided to replace the existing restorations from 13-23 – right canine to left canine, and place conservative veneers on 14&24 – right and left first premolar, a total of 8 units...

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Before and After 2016: Smile Makeover – Full Mouth Reconstruction with a Heart-warming Testimonial

A female patient in her 50s was referred to me for a consultation, who literally got ‘hit by a bus’ in an accident. Multiple facial reconstruction and surgeries had been performed, yet she was dissatisfied with the dental work provided.   After a lengthy discussion with the patient and the treating clinician, we decided to restore her brand-new smile with confidence by performing a full-mouth reconstruction. There were existing implant restorations from 12-22 – the right lateral incisor to the left lateral incisor, replaced in Screwed-Retained Implant bridge. The rest to be done in lithium disilicate (e.max).   Fig 1 shows the pre-op condition. The patient’s lower lip was still hanging down at this point (due to the trauma), and thus she showed more...

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Before and After 2015: Smile Makeover – Replacement of 2 Teeth on 1 Abutment with Pink Ceramics

A Caucasian female patient in her 20s was just about to get married and wanted to look the best. She was missing laterals with vampire-like fangs that bothered her. Because of the timeframe, orthodontic treatment was not an option.   Since the teeth are all vital, we need to be conservative in prep generally, but the aggressive prep is necessary where required. Boding strength is another element we must consider. Thus, we decided to go with lithium disilicate (e.max) restorations – veneers on the central incisors and first-premolars, with joint crowns to replace the laterals and canines off one abutment for each quadrant.   Fig 1 shows the pre-op condition. When working a case like this, the communication between the clinician and technician is...

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Before and After 2014: Smile Makeover – Addressing Mid-line Cant and Proportion with Lateralised Canines

A Middle Eastern female patient was concerned about her smile’s asymmetry, cased by the midline cant and shift with missing laterals. The lateralised canines are as wide as the central incisors, so the overall proportion needs improvement. It is not visible in the initial smile photo, but the patient has a gummy smile, which she would like to address simultaneously.   When working on a case like this, initial planning is crucial to visualise the outcome from the beginning, and thus, diagnostic wax-up is a must. We have decided to idealise the gingival level by crown-lengthening/gum-contouring, to begin with, then lithium disilicate (e.max) veneers from 13-23, right upper canine to left upper canine, a total of 6 teeth.   Figs 1-4 show the pre-op condition. The...

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Before and After 2013: Smile Makeover – Implant Zirconia Bridge with Gum Porcelain

An Asian patient in her 40s was depressed about the aesthetics of her smile. She had several attempts to replace the restorations to achieve natural aesthetics, which she found difficult. She was looking for “a durable, functional and, most of all, a beautiful smile” in her words.   The treatment plan is to replace the existing restorations – 12-22 Screw-Retained Implant Bridge, and crowns on the canines - 13 and 23. To maintain the same property and material in the superstructure, we decided to use Zirconia with Ti interface abutment for the implant connections.   Fig 1 shows the pre-op condition. The aesthetical and functional issues we need to address are: correction of the midline cant achieving a sense of symmetry on the central...

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Reproducing Nature Part 4: Smile Design

LVI Visions featured Yugo’s article titled ‘Reproducing Nature: Smile Design in 2008 (published language: English).   Introduction:   Today, creating a natural-looking smile is essential in cosmetic/aesthetic dentistry. As I mentioned in the first part of this article (European Journal of Eesthetic Dentistry Winter 2008), many people think that white “Hollywood Smiles” look fake but is it true? Have you thought about bleached natural dentition? I think it looks healthy and attractive but doesn’t look fake at all. That is the type of benchmark I set for myself when the patient is after a perfect smile – i.e., bright yet natural.   Now, what is the definition of “perfect” anyway? Does it mean that it’s perfectly in proportion, perfectly adapted to the patient’s desire or could...

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Before and After 2012: Smile Makeover – Achieving Significant Change in Proportion with porcelain veneers

A Caucasian male patient in his 30s was deeply concerned about the aesthetics of his smile. There are several issues we had to address: most notably, changing the proportion and tooth size within the aesthetic zone, crown-lengthening/gum-contouring, and a replacement of a missing tooth on 14 (right first-premolar).   We selected a Zirconia bridge on 15-13, and lithium disilicate (e.max) veneers for the rest – 12-26 (missing 25), from the right second-premolar to the left first-molar, a total of 10 units.   I must admit that this case was one of the most challenging smile makeovers I had encountered at that time, but the result spoke for itself. The patient was “over the moon” with the outcome.   The key to achieving such a result was...

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Before and After 2011: Setting a Benchmark in Digital Photography

A male patient in his 30s presented with the aesthetic concerns on the gummy smile and prominent hypocalcification on the central incisors. Hypocalcification is a condition where your tooth’s enamel has an insufficient amount of calcium. When this happens, the enamel still covers the tooth’s surface but parts can be thin and weak, giving teeth an opaque or chalky appearance.   We decided to proceed with crown-lengthening, to begin with, and lithium disilicate (e.max) veneers on the central incisors for the better blend with the rest of natural dentition.   Figs 1, 3 and 5 show the pre-op condition. Figs 2, 4 and 6 show after completion of the crown-lengthening for the upper arch. See the consistency in the provided photos – retracted view,...

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Reproducing Nature Part 3: Tooth Replacement with Root and Colour Matching Using Digital Photos

eLABORATE Magazine featured Yugo’s article titled ‘Reproducing Nature Part 3: Tooth replacement with root and colour matching using digital photos in 2006 (published language: English).   Introduction:   The technology available in dentistry in 2006 has improved significantly since I became a dental technician even though it’s been only eight years. Patients’ dental IQ and desires for beauty have also increased through exposure in the media.   Thanks to the advancement of software such as Adobe Photoshop, we can now give patients a new smile digitally/virtually before the commencement of work to provide them with a great idea of the final result with the projected outcome.   Material-wise, the trend has moved to metal-free restorations over traditional PFMs – higher aesthetics with less effort to achieve life-like restorations....

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Before and After 2010: Treatment of Cleft Lip and Palate – a “Pro-bono” Smile Makeover

A female patient in her early 20s presented with congenitally missing upper lateral incisors, and one canine, a total of 3 teeth seeking a fixed replacement. The patient has a cleft lip and palate bilaterally, which has been treated several times over the years with surgery to repair it. Implants are not possible as there is no bone in the surgical repair sites, and in fact, she still has an oro-nasal communication.   The patient had limited resources to pay for treatment and hoped that the federal Cleft Lip and Palate Scheme would cover the costs, which turned out that only extractions and dentures are eligible for the claim. Thus, the treating clinician – Dr Michael Mandikos and I had decided to treat...

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Before and After 2009: Soft-Tissue Management at the Socket on Pontic Sites

A Caucasian male in his 70s had presented with failed roots on the lateral incisors (12 & 22). The patient was also concerned about the aesthetics of the overall smile, wanting to have a youthful look. We commenced the case with 2 x Zirconia bridges 13-11 & 21-23.   Fig 1 shows the pre-op condition. 12 and 22 were extracted, and the soft tissue was managed during the temporary stage by the treating prosthodontist. Fig 2 shows the remarkable state of the soft tissue recovery.   Communication in the shade taking is essential between the clinician and ceramist. The shade tab should be placed edge to edge position, as shown in Fig 3. Fig 4 shows the completed Lava zirconia bridges (13-11 & 21-23). Note...

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Reproducing Nature Part 2: Blending into Natural Dentition

eLABORATE Magazine featured Yugo’s article titled ‘Reproducing Nature Part 2: Blending into natural dentition’ in May/June 2006 (published language: English).     Introduction:   Isn’t colour matching a restoration to nature one of the hardest things for all of us to achieve? To be able to reproduce the colour, there are so many factors we have to consider and get right. The value, chroma, hue, translucency, characterisation and even the surface anatomy and shine control of the tooth are all essential considerations.   However, from my perspective as a ceramist, we have to consider another crucial aspect – the background. The teeth in the mouth are always under the influence of the colour from the gum, and it is very easy for human eyes to make misjudgements...

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CORRECTION OF MIDLINE CANT WITH A SINGLE CENTRAL INCISOR

The primary objective of treating a single central incisor is to create a restoration that blends in with the surroundings. The two front teeth - upper central incisors -are the most dominant part of the smile, and they are used to determine the position and cant of a facial and dental midline. Studies suggest that the most important relationship to evaluate the aesthetics is the mediolateral inclination of the maxillary incisors. If the incisors are inclined by 2mm right or left, laypeople regard this as unesthetic.   Figs 1 & 2 show a trauma case with damaged right upper central incisor – 11. The assessment of the facial midline can only determine with a full-face photo; however, the images suggest enough to indicate...

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Before and After 2008: Welcoming my Inaugural Patient at Smile by Yugo

A Caucasian male in his 30s presented with a trauma case on the (patient’s) right central incisor (11) – had an accident while playing football. He was also concerned about the appearance of the (patient’s) right lateral incisor (12) – it appears too short and narrow in his words.   11 is a non-vital tooth with minor discolouration in the stump (c.f., Fig 1); thus, we selected a zirconia restoration. The opacity of Lava Zirconia was suitable for slight masking, and its aesthetic advantage in complex colour matching.   12 is a healthy, vital tooth clinically speaking (c.f., Fig 1), thus we required only a minor conservative prep to proceed with the refractory veneer. Additionally, bleaching was completed two weeks before the shade taking...

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