Introduction to the case
This is one of my most MacGyver cases to date. This patient has extensive damage from wear and erosion and was ready to restore his mouth before it gets any worse. He is now a faithful nightguard wearer but nonetheless, those masseters made me really nervous.
I like to test drive big cases in composite before committing to porcelain because if they’re going to be breaking stuff, it sure helps to figure out why and correct it before proceeding to finals. You can certainly do it with just a bisacryl overlay but it tends to pop off and you can’t really leave it on as a buildup. Doing the mockup in a real composite allows you to break the teeth up individually for flossing and allow them to wear it longer. It also serves as a buildup by filling in deficient areas of tooth.
In this case, I generated a template from a waxup and used it to injection mold the intraoral mockup. The contacts were broken by inserting mylar strips interproximally.
I chose to use Activa here for a variety of reasons. It is injectable, it’s dual cure, it doesn’t have to have a bonding agent, and it is very resistant to wear and chipping. The bioactive aspect is icing on the cake making it far less likely to have secondary decay.