I am a strong believer in patient approved provisionals in cases where we are making esthetic changes to anterior teeth. I have patients back a week or two after placing anterior provisionals. This appointment is designed to review the appearance and get the patients approval prior to sending the case to the lab for fabrication of the final restorations. Additionally we test the phonetics and function. If everything is a go we photograph the patient and take a model of the approved provisionals to send to the technician.
Commonly patients are curious about changes and how the esthetics would be impacted. These alterations are either additive, like increasing incisal edge length or subtractive, opening an embrasure or eliminating a slight lisp. I prefer to make subtractive changes, so to this end I plan my incisal position on the longer side of what I think will work. When they changes are additive, flowable can be added without air abrading, or etching and applying a layer of resin as a test. If the addition isn’t what they hoped for, it will simply flick right off, and if they love it, then make it official by bonding the changes into place.
The challenge of reductive changes is once I take a bur out and remove the bisacryl, if they are not pleased with the result adding it back requires bonding more material in place. Reductive changes can be tested very simply with a black sharpie marker. Simply black out the bisacryl to make the esthetic changes. If you step back and look, or the patient holds a mirror out and looks you will see the visual impact the changes will have. If the patient loves it, take out a bur and make the alteration permanent.
It can be frustrating to make changes to the provisional restorations, only to have the patient decide they preferred the original appearance, so have ways they can communicate what they want and test the changes first.
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