PMC4983345_01
Initial smile of this patient.
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Anterior disclusion and laterality were absent (Figures 1 and 2).
Close-up view of frontal (a) and lateral (b) anterior teeth showing worn and stained composite resins. (c) Image of right disclusion showing contact of canine as well as lateral and central incisors.
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Anterior disclusion and laterality were absent (Figures 1 and 2).
Final diagnostic appearance.
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After 7 days, a wax model was developed for diagnosis (Figure 3).
Mock-up made with bis-acryl resin.
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A Protemp 4 (3M ESPE) was inserted into the silicon from the wax-up, and a mock-up was made to assess the size and form of the wax model (Figure 4).
Wear guide made with addition of silicone over wax (a) and on teeth (b) during wear of composite resins to assess thickness of the restoration material.
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After removal of the resin from each tooth, the vestibular space needed for the ceramic was estimated using a wax wear guide (Figure 5).
Teeth immediately after preparation. Note gum inflammation caused by the resins.
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To complete the preparation, the teeth were finished and polished with diamond points using a speed multiplier (W & H Dentalwerk, Burmoos, Austria; Figure 6).
(a)-(d) Model with die in position for creation and ceramic finish to allow for an extremely precise and conservative restoration.
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fig7
Tambore, Brazil) was used to make the ceramic laminates (Figure 7). The cervical and proximal finish was performed using stones and ceramic rubber (Zzag, Curitiba, Brazil).
PMC4983345_02
Teeth after removal of temporaries. Note the improvement in papillae after removal of the resins that were causing inflammation.
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At this time, we could already see an improvement in the appearance of the gingiva after removal of the resins that were causing inflammation (Figure 8).
PMC4983345_03
(a)-(c) Ceramic laminates after cementation. Note the disclusion due to the reestablished canine.
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fig9
An occlusal adjustment with ceramic rubber was prepared and checked against the anterior disclusion and laterality guides (Figure 9).
(a)-(b) The final smile achieved for this patient.
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The final smile in this patient is shown in Figure 10 and the outcome at 18 months can be seen in Figure 11.
(a), (b), (c) Occlusal and periodontal control and esthetic stability of restorations after 18 months of follow-up.
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fig11
The final smile in this patient is shown in Figure 10 and the outcome at 18 months can be seen in Figure 11.