PMC5572585_01
Intraoral image, showing disharmony in position and size, dental attrition, and erosion.
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Digital smile design (DSD). Planning of the anterior teeth proportions for the wax-up.
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After a thorough clinical examination, a digital smile design was performed to decide the correct anterior tooth proportions (Figure 2) which includes tooth 14 to tooth 24.
Wax-up, identical in form from the DSD.
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This design was transferred to a diagnostic wax-up in which the enamel loss could be appreciated by the amount of wax over the cast model (Figure 3).
3D resin model obtained from the wax-up scanning.
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Once the wax-up was done, it was digitalized with a model scanner (dental wings 3 series) and printed into a 3D resin model (PASTCure Model 310) (Figure 4), in which a silicone matrix was fabricated for the mock-up technique.
Mock-up with bisacrylic resin (Luxatemp Star A1, DMG). Notice the shape, which is the same as the DSD planning.
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fig5
The mock-up was done with bisacrylic material (Luxatemp Star A1, DMG) and is shown in Figure 5.
Orientation grooves for the vestibular reduction.
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The first step includes the creation of orientation grooves (868B.314.018, Komet) for the vestibular reduction (Figure 6) through the bisacrylic material.
Vestibular reduction until the painted grooves are removed; this ensures a controlled reduction for the ceramic space.
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Then, a tapered shape bur was used to complete vestibular reduction (6850.314.016, Komet) until every marked groove was removed (Figure 7). 1,5 mm grooves for the incisal reduction were done, followed by the proximal preparation, which was made with an 8850.315.016 tapered diamond bur, and finally, a diamond disc (952.180 + 310.204, Komet) was necessary for the elimination of the contact point between 11 and 21 tooth due to a misalignment problem.
Finished tooth preparations.
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An image for the all tooth preparations after polishing can be shown in Figure 8.
Intraoral scanning.
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A retraction cord was placed into every sulcus of the prepared tooth (000, Ultrapak, Ultradent Products Inc.). 3D digital impression was performed using an optical intraoral scanner (MHT IntraOralScanner, MHT Optic Research, Zurich, Switzerland) and then digitalized (Figures 9 and 10).
Digital model with the finished preparations for the ceramic digital design.
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fig10
A retraction cord was placed into every sulcus of the prepared tooth (000, Ultrapak, Ultradent Products Inc.). 3D digital impression was performed using an optical intraoral scanner (MHT IntraOralScanner, MHT Optic Research, Zurich, Switzerland) and then digitalized (Figures 9 and 10).
Milled e.max CAD blocks.
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The immediate result of the milling process is shown in Figure 11.
Ceramic layering technique. (a) The fitting of the veneers is being checked. (b) Power Dentin (IPS e.max Ceram) is being applied. (c) A final layer application of Power Enamel (IPS e.max Ceram).
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fig12
Then, every milled block was layered with a nanofluorapatite ceramic for the final incisal edge optics (IPS e.max Ceram, Ivoclar Vivadent, Liechtenstein, Germany) (Figure 12).
Finished ceramic veneers and vestibular and intaglio surface view.
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fig13
The final result of the sintering and glaze procedure is shown in Figure 13.
Try-In +2 value.
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In this case, value +2 of Variolink Veneer resin cement system was used (Try-In +2, Variolink Veneer, Ivoclar Vivadent, Liechtenstein, Germany) (Figure 14).
Ceramic treatment surface. (a) The conditioning of the veneer with 5% hydrofluoric acid for 20 seconds. (b) Silane application (Monobond Plus, Ivoclar Vivadent, Liechtenstein, Germany). (c) Application of bonding agent (Heliobond, Ivoclar Vivadent, Liechtenstein, Germany).
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A final thin layer of bis-GMA bonding agent was applied (Heliobond, Ivoclar Vivadent, Liechtenstein, Germany) without light curing and protected from the light (Vivapad, Ivoclar Vivadent, Liechtenstein, Germany) (Figure 15).