PMC5808436_01
a) Initial apearance of patient smile and with b) unfavorable dental proportions and diastema between lateral incisors and upper central.
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F1
Upon clinical examination, the presence of a disharmonious smile with proclined lateral incisors, unfavorable dental proportions, diastema between lateral incisors and upper central, in addition to inadequate gingival contouring and zenith (Figures 1a-b and 2).
Intraoral view of teeth in occlusion. Patient with stable occlusion.
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F2
Upon clinical examination, the presence of a disharmonious smile with proclined lateral incisors, unfavorable dental proportions, diastema between lateral incisors and upper central, in addition to inadequate gingival contouring and zenith (Figures 1a-b and 2).
Digital smile analysis and planning for periodontal surgery before restorative procedures.
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F3
Surgery was then recommended for crown enlargement of teeth 7 to 10 (universal numbering system) (Figure 3).
a) Silicone index for mock-up, b) wax model and c) aspect of the patient after mock-up.
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F4
In the next session, an impression with vinyl polysiloxane/silicone was made (Express XT [commercially available in the United States as Express VPS] 3M ESPE, St Paul/MN, USA) to prepare stone models, a diagnostic wax-up, and mock-up (Systemp/Ivoclar Vivadent, Schaan, Liechtenstein) of teeth 6 to 11, according to the digital smile design (Figures 4a-c).
Index positioned on the teeth before preparations: a) buccal and b) incisal view.
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F5
In order to guide all steps of teeth preparation, an index was made with a condensation silicon (Zetaplus/Zhermack, Sao Paulo, Sao Paulo, Brazil) (Figures 5a-b).
Clinical aspect after final preparation of the anterior teeth.
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F6
Because the preparations were minimally invasive, there was no need to manufacture temporary veneers (Figure 6).
3D images of the veneers from 13 to 23 on the scanned model of the prepared teeth: a) buccal and b) incisal view
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F7
The stone models were scanned and the ultra-thin veneers were fabricated with monolithic translucent zirconia (Prettau Anterior, Zirkonzahn, Gais, Switzerland) (Figures 7a-b) and milled in a Zirkonzahn CAD/CAM system (Gais, Switzerland).
Resin cement color test of ceramic veneers with Try-in pastes (Variolink Veneer, Ivoclar vivadent) of medium value 0 (left) and low value -3 (right). The cement of medium value 0 was selected.
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F8
Ivoclar Vivadent, Schaan, Liechtenstein). It was possible to observe that the color was significantly affected by the shade of the try-in paste (Figure 8).
PMC5808436_02
Teeth surface treatment - a) Etchingwith 35% phosphoric acid/15s; b) Application the adhesive on the the tooth surface; c) Removal of excess cement with a thin brush and dental floss; d) Cement photopolymerization with glycerine gel application on the adhesive interface.
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F9
Next, glycerin gel (Liquid strip, Ivoclar Vivadent, Schaan, Liechtenstein) was applied to the cervical and incisal regions of veneers and another curing cycle was performed on each face (Figures 9a-d).
a) Final intraoral view in oclusion; b) Close-up view of the central incisor characterization.
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F10
The clinical appearance of the veneers after luting and one year follow-up can be seen in Figures 10a-b and Figures 11a-b, respectively.
Final a) smile and b) facial aspect after one year follow-up.
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F11
The clinical appearance of the veneers after luting and one year follow-up can be seen in Figures 10a-b and Figures 11a-b, respectively.