Date of Case Report Publication
Athens, 12. 2015
Author
Kleanthis Manolakis, DDS, Dr. Med. Dent.
Journal
Dental Journal, Omnipress Publishing Company
Navigation leads the way – safety and predictability in contemporary implantology
Introduction
Nowadays patients not only expect to have functionally flawless treatment results, but also increasingly demand significant aesthetic appearance improvements. Symmetrical and radiantly white teeth are attractive and considered an expression of vitality and health. On the contrary unaesthetic, crooked or discolored teeth can often lead to insecurity and psychologically induced social contact restrictions. Modern aesthetic dentistry can meet patients’ desire for cosmetic improvements in gentle and minimally invasive ways. Impressive changes in tooth color, shape and surface texture can be achieved in many clinical cases with ceramic veneers. All-ceramic veneers comprise one of the established concepts of modern aesthetic dentistry. Careful treatment planning plays an important role in achieving optimal aesthetic outcomes. Equally important is the close cooperation between dentists and dental technicians involved. The patient case presented concerns a young female colleague, 24 years old. She had just passed her state exam in dentistry and wished to specialize in aesthetic dentistry. Accordingly she was very keen to have her two upper central incisors restored in a minimally invasive and aesthetically exemplary manner. Her central incisors were badly damaged in a skateboard accident. The mesial incisal corner of the right lateral incisor was also slightly injured; however she initially wanted to limit treatment to the central incisors only. The clinical cold test and an X-ray image excluded potential pulp involvement in the injury – both front teeth are vital. Both central incisors are dominated by extensive composite fillings; still aesthetic results achieved are rated as unsatisfactory by the patient. Periodontal condition of all upper front teeth is optimal, oral hygiene is performed by the young dentist in an exemplary manner.
Aesthetic treatment planning
An ideal wax-up design of the two teeth requiring reconstruction is transferred directly to the involved teeth intraorally using a laboratory-made wax-up (Luxatemp, DMG). Mock-up is evaluated as an essential step in aesthetic case planning; it supports the communication between patient, clinician and laboratory technician enormously. It assissts both patient and clinician to visualize the shape and contour of the final restoration and to modify it accordingly if necessary. For example one can use a black felt-tip pen to imitate an incisally shorter variant of the definitive restoration directly intraorally on the mock-up if this is desired by the patient.
Tooth preparation
When there is unity achieved between clinician and patient about the potential aesthetic result, definitive preparation can be initiated directly via the mock-up at the same appointment. A gentle preparation of the natural teeth should be performed. At the cervical area the preparation margin should be in intact enamel. Approximal contact points are preserved in natural enamel. Impressions are then performed with VPS (Honigum, DMG) and, if necessary, prepared teeth should be provisionally restored.
Veneer fabrication in the dental lab
In this particular clinical case ceramic veneers were made of lithium disilicate (Emax Press, Ivoclar), having a particularly delicate surface characterization. Only a thin transparent layer was applied.
Intraoral adhesive cementation
At the cementation appointment provisionals are removed and tooth surfaces are pretreated with the intraoral sandblaster and fine aluminum oxide (27μ). In this way, decontaminated and extremely clean adhesive surfaces are obtained. A fundamental advantage of the adhesive & try-in paste combi-set is that the definitive shade can be precisely visually checked before cementing using the shade-corresponding try-in paste. Accordingly one can try out different try-in pastes and thus slightly modify the final shade nuances just before cementing. The light-cured composite cement Vitique White (DMG) was then used for the definitive bonding of the two ceramic veneers. The two ceramic veneers in situ after adhesive cementation and excess removal are characterized by a natural appearance. The entire upper jaw frontal area looks harmonious and lively again. The young lady radiates new self-confidence and shows her new smile very proudly. Having the patient smiling with loose lips new ceramic veneers impress with their natural appearance. The masterful dental technical performance is convincing.
6 months follow-up
During her recall appointment 6 months later all aesthetic and functional aspects are assessed again. Surrounding soft tissues are absolutely free of inflammation. The perfect fit and careful cementing of the restorations, as well as her excellent daily oral hygiene contribute significantly to the natural incisors’ periodontal health.
Conclusion
Important keys to success while aesthetic restoring of ceramic veneers are extensive patient communication and extensive planning and cooperation with a talented dental technician. Team spirit is the right word here. Precise execution of the preparation and selection of high-quality manufacturing techniques and materials contribute significantly to the longevity of the restorations. The final result should fully satisfy our patients, the dental technician and the clinician, only then is the effort justified. Ceramic veneers are certainly among the highest quality and most aesthetically pleasing techniques in modern aesthetic dentistry.
