I am revisiting a case that I completed a couple of years ago. As I look back, I am wondering if I would have done it the same way today. Any feedback would be MUCH appreciated. Be gentle, this is my first case to post on here.

Pt is a 51 y/o male with non-contributory medical history. C/c of "I would like to improve the look and color of my teeth". Pt works in the petroleum industry and would like to keep visits to a minimum so that he doesn't have to miss work.

Initial Visit Photos

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The only decay was on the Mesial of both lower first molars (were replaced with resins). # 8 is an existing PFM with gold lingual. It has been previous endo treated and has a large active threaded post. Bone support appears adeduate and there are no other perio issues. The wear on pre-dominantly on the anterior. No apparent loss of OVD. TMJ and range of motion all appear to be healthy/asymptomatic.

Facebow and CR records taken (leaf gauge) and a 1.5mm slide anteriorly was noted on the verified mounting. Model equilibration was completed and it was determined the pt could be equilibrated. A custom incisal guide table was fabricated and a diagnostic wax-up was completed. The equilibration was carried out intraorally. New casts were taken along with CR records. The slide disappeared when re-mounted and the CR mounting verified.

QUESTIONS - My diagnostic wax up was made on the equilbrated models. While it translated well to the mouth (the equilibration was completely reductive), is there an argument to re-do the wax up on the casts after the equilibration was completed intraorally?

The patient was not open to ortho due to the number of visits and subsequent interruption is his work schedule . Based on the wax up, I felt that I could equilibrate the lower anteriors with plasty and only need to restore the upper 8 with porcelain and do the lower abfractions in composite. The custom incisal guide table was used to free up space in the wax up. The maxillary incisors would need to be proclined slighlty to make adequate room. This appeared possible to do without encroaching on the pulps. THe pt did not show the ginigval levels in his smile. We discsusued that the canines would appear long do to the current abfractions/gingival posiiton.

To get broad contacts in excursives with the wax up, I had to lengthen the maxillay laterals slighly longer that I would ideally like. Is there another way to accomplish this?

A mock up with made with a suck-down matrix and # 4-12 were prepped for full coverage. The plan was to restore with PFMs with metal linguals to mask the color of the UGLY post in # 8. We discussed that, if this tooth should give out, an implant would most likely be in his future (sorrry, I don't ahve a pic of the PA handy). Below are pics of the preps and provisionals. The lower anteriors were equilibrated to the provisonals based on the wax up. The pt wore the provisionals for two months with no breakage or TMJ symptoms.

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The provisionals were splinted. The final restorations obivously will not be. How confident can I be that, if I had no problems with splinted provisionals during the trial phase, that this will carry over to the non-splinted finals?

Do you think we could mask this with the LT ceramics today?

Final restorations - Pt it two years in and (knock on wood) hasn't had any problems yet. # 8 still makes me nervous due to the big active post and potential for fracture. A nightguard was fabricated but, per the patient, he "doesn't wear it often". :-/

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What could I have done different/better?