PMC6305029_01
(a) Initial photo of patient's right side. (b) Initial photo frontal view. (c) Initial photo of patient's left side.
CRID2018-5368939.001.jpg
PMC6305029_01_CRID2018-5368939.001.jpg
fig1
Patient R.C., 52-year-old male subject, sought for dental treatment demonstrating dissatisfaction with the upper anterior teeth aesthetics, which had extensive composite resin restorations, pigmentation, spots, and infiltration (Figure 1).
(a) Initial X-rays. (b) Initial study models.
CRID2018-5368939.002.jpg
PMC6305029_01_CRID2018-5368939.002.jpg
fig2
After the anamnesis, as well as the X-rays, photographs and upper and lower arches' evaluation (Figure 2), the case was prepared and an aesthetic rehabilitation treatment was proposed, consisting of a ceramic crown, with zirconia infrastructure in element 15 and laminated veneers, with feldspathic ceramics in elements 11, 12, 13, 14, 21, 22, 23, 24, and 25.
(a) Digital smile design. (b) Wax-up upper arch.
CRID2018-5368939.003.jpg
PMC6305029_01_CRID2018-5368939.003.jpg
fig3
Following the references from the digital smile design, which is performed using pictures of the face and smile of the patient and a computer program, PowerPoint (Microsoft) or Keynote (Mac), it is possible to correct positioning and minor glitches using smile lines and median with teeth proportionality; a diagnostic wax-up of the upper model was produced (Figure 3), and based on it, silicon guides were made to create the mock-up, guide the enamel/dentin preparation, and subsequently assist in the preparation of a temporary crown with bis-acryl resin.
(a) Silicone guide on the wax-up model. (b) Silicone guide cut along the long axis of the tooth. (c) Preparation using the guide. (d) Preparation finalized.
CRID2018-5368939.004.jpg
PMC6305029_01_CRID2018-5368939.004.jpg
fig4
Considering tooth 15, a metal-free preparation was made to cover the full crown with zirconia infrastructure; elements 14, 24, and 25 were chosen for inverted-type 4/5 preparations, and for the anterior teeth, tooth preparation for laminated veneers with incisal wear and no overlap was considered for the treatment (Figure 4).
Mold.
CRID2018-5368939.005.jpg
PMC6305029_01_CRID2018-5368939.005.jpg
fig5
A-silicone was positioned (Flexitime, Heareus Kulzer) (Figure 5). After analyzing the mold quality, the temporary crowns were prepared with A3-colored bis-acryl resin (Structur, Voco), using the silicone guide built on the model with diagnostic wax-up (Figure 6).
(a) Silicone mold filled with bis-acryl resin. (b) Temporaries in position.
CRID2018-5368939.006.jpg
PMC6305029_01_CRID2018-5368939.006.jpg
fig6
A-silicone was positioned (Flexitime, Heareus Kulzer) (Figure 5). After analyzing the mold quality, the temporary crowns were prepared with A3-colored bis-acryl resin (Structur, Voco), using the silicone guide built on the model with diagnostic wax-up (Figure 6).
Die-cut model.
CRID2018-5368939.007.jpg
PMC6305029_01_CRID2018-5368939.007.jpg
fig7
The working model was obtained using stone rock type IV (Elite Rock, Zhermack) and then punched (Figure 7) through the Accutrac system (Coltene/Whaledent), in laboratory, for later duplication and confection of the veneers in feldspathic ceramics (IPS Empress II, Ivoclar Vivadent) (Figure 8).
(a) Finished parts in the die-cut model. (b) Veneers in feldspathic ceramics.
CRID2018-5368939.008.jpg
PMC6305029_01_CRID2018-5368939.008.jpg
fig8
The working model was obtained using stone rock type IV (Elite Rock, Zhermack) and then punched (Figure 7) through the Accutrac system (Coltene/Whaledent), in laboratory, for later duplication and confection of the veneers in feldspathic ceramics (IPS Empress II, Ivoclar Vivadent) (Figure 8).
(a) Patient smile at the end of treatment. (b) Intraoral view of cemented parts.
CRID2018-5368939.009.jpg
PMC6305029_01_CRID2018-5368939.009.jpg
fig9
The excess cement was removed with the aid of scalpel blade number 15c (Solidor) and polished with silicone cups and felt disks (Figure 9).