PMC4074967_01
Intraoral anterior view of teeth before treatment.
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fig1
Previous orthodontic treatment did not completely solve the right lateral incisor rotation (Figure 1).
(a) Preoperative cast. (b) The same cast with horizontally sectioned silicon index of wax-up.
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Impressions were poured in type IV dental stone; the models were mounted on a semiadjustable articulator (Figures 2(a) and 2(b)).
(a) Frontal view of the mock-up made in PMMA resin of teeth 11-12. (b) Occlusal view of the same mock-up.
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Intraoral try-in of the mock-up and provisional cementation.
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During a second appointment the preliminary resin mock-up was tried, checked, and provisionally luted (Figure 4); any alteration desired by the patient and the clinician was analyzed, discussed, and adjusted.
Minimal tooth preparation areas marked on the preoperative cast.
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After all information was obtained by the mock-up, the technician checked the space available for the veneers and the path of insertion and highlighted on the dental stone model the areas requiring clinical preparation (Figure 5).
Interproximal preparation using finishing strip.
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fig6
In order to facilitate the impression and cementation protocols, interproximal space between central incisors was at first widened using coarse/medium finishing strips (each of them has two different abrasive grades) (Sof-Lex, 3M ESPE); subsequent surface refinement was performed by fine/superfine strips of the same system (Figure 6).
Refined and polished surfaces before final impression.
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Ultrapak retraction cord in situ.
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The cord was left in the sulcus during the entire impression procedure; this technique limits the flow of crevicular fluid and provides correct moisture control (Figure 8).
(a)-(b) Impregum Duosoft light body material injection.
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A high quality polyether precision material was used (Impregum Penta Duosoft, 3M ESPE) to take a one-step, double mix final impression; a light body (Duosoft L, 3M ESPE) was applied at the gingival margin and gently blown over the preparations (Figures 9(a) and 9(b)).
Detail of the final elastomeric impression.
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fig10
A full metallic tray was loaded with the heavy body impression material (Duosoft H, 3M ESPE), inserted in the oral cavity, and allowed to set according to the manufacturer's instructions and then removed (Figure 10).
(a)-(b) Buccal and palatal view of the upper ditched master cast.
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A working model of the upper arch was obtained by pouring the definitive elastomeric impression (Figures 11(a) and 11(b)).
Wax-up for definitive restorations.
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The dental technician prepared a wax-up on the working cast, reproducing all diagnostic information previously approved by the patient (to accomplish this step, the clinician recorded and sent to the laboratory an alginate transfer impression of the mock-up in situ) (Figure 12).
(a) Wax-up silicon index. (b) Microhybrid resin composite veneers fabrication.
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fig13
Whaledent) was positioned at the inner surface of a silicon index and composite restorations of the four upper incisors were baked on the working model (Figures 13(a) and 13(b)). While for teeth 11, 21, and 22 vestibular and incisal areas were covered by the veneers, for the upper right lateral (tooth 12) the mesiopalatal surface was also involved.
(a)-(b) Finished and polished restorations.
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fig14
Dental GmbH, Ratingen, Germany) and disks (Sof-Lex, 3M ESPE) allowed the fabrication of life-like veneers (Figure 14(a)). Definitive restorations were seated on the working model and sent to the clinician (Figure 14(b)).
Evaluation of the shade and fit using try-in paste.
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The teeth were cleaned with pumice and dried and a transparent try-in paste was applied on the intaglio surface (Variolink try-in paste, Ivoclar) (Figure 15).