PMC4326350_01
Initial clinical aspect, frontal view.
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All those elements showed unacceptable lifelike esthetic appearance, high opacity (mainly on canines), color mismatch, and lack of texture (Figure 1).
Prepared teeth.
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It was observed that the metal cores of the anterior maxillary incisors were properly adapted and all the restored teeth had a satisfactory preparation design (Figure 2).
Gingival displacement with retraction cord. Note patient's gingival biotype proper for this impression technique.
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The soft tissue displacement was performed with gingival retraction cords (Ultrapak, Ultradent Products Inc., South Jordan, Utah, USA) because the patient gingival biotype showed a satisfactory thickness (Figure 3), minimizing the risks of irreversible gingival recessions.
Definitive impression.
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Paul, Minnesota, USA) (Figures 4 and 5).
Definitive impression, close-up view of preparations finish line.
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Paul, Minnesota, USA) (Figures 4 and 5).
Emergency profile guidelines.
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The restorations were divided into thirds associated with emergency profile guidelines allowing the gradual ceramic layering and whitening the restoration from cervical to incisal plane (Figure 6).
Surface texture reproduction with graphite.
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Graphite was scratched on the restorations surface to reproduce the lifelike texture and characteristics of natural teeth (Figure 7) and gold powder was applied to visualize the regions of high and low brightness (Figure 8).
Surface texture reproduction with gold powder.
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Graphite was scratched on the restorations surface to reproduce the lifelike texture and characteristics of natural teeth (Figure 7) and gold powder was applied to visualize the regions of high and low brightness (Figure 8).
Porcelain laminate veneer.
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After the all-ceramic restorations were finalized (Figure 9), their inner surface was etched with 10% hydrofluoride acid gel (Dentsply, Petropolis, Rio de Janeiro, Brazil) for 20 seconds according to the manufacturer's instructions (Figure 10).
Surface etching with 10% hydrofluoric acid gel.
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After the all-ceramic restorations were finalized (Figure 9), their inner surface was etched with 10% hydrofluoride acid gel (Dentsply, Petropolis, Rio de Janeiro, Brazil) for 20 seconds according to the manufacturer's instructions (Figure 10).
Silane application.
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Next, silane was applied on the etched surface for 60 seconds (Figure 11); then its excess was removed by air jets, so the restorations were prepared for cementation step.
Dual-curing resin cement placement on the inner surface of all-ceramic restoration.
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The adhesive agent (Monobond Plus, Ivovlar Vivadent AG, Schaan, Liechtenstein) was applied to the surfaces and each layer was photopolymerized for 20 seconds (Figure 12).
Removal of resin cement excesses.
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Their excesses were removed (Figure 13) and the photopolymerization was performed.
Final aspect of treatment, immediately after cementation procedure.
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After the cementation, the color of the all-ceramic restorations matched with the patient's natural teeth (Figure 14).
Lifelike esthetic result. Note the light transmission on restorations surface.
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The color graduation and teeth translucence in the incisal third were more detailed and evident (Figures 15 and 16) which reproduced the lifelike esthetic appearance of natural teeth.