PMC5559911_01
Initial appearance of the patient's smile from the front (a) and lateral (b) perspectives. She was dissatisfied with the shapes, sizes, and color of her teeth. Lips at rest show the excessive opacity of the prosthesis on the right side lateral implant (c).
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Radiographic examination confirmed the presence of the implant and the health of adjacent tissues (Figures 1 and 2).
Detail of anterior teeth, showing imbalance of maxillary gingival arch harmony and unsatisfactory resin restoration on the left side lateral incisor. Front (a) and left (b) details of the maxillary anterior teeth.
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Radiographic examination confirmed the presence of the implant and the health of adjacent tissues (Figures 1 and 2).
Model of diagnostic wax-up. Note the more defined and triangular contour of the buccal proximal edges.
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A diagnostic wax-up was done on the maxillary arch model (Figure 3).
Probing after the scaling and prophylaxis sessions, performed prior to the surgical treatment (a). The smile line was marked with dental floss (b). Gingival recontour with an electric scalpel on the right side (c). Appearance immediately after gingival recontour (d).
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Postoperative follow-up was done after 3 months (Figure 4).
In-office bleaching with hydrogen peroxide.
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Four weeks of home bleaching with 10% carbamide peroxide was recommended (Pola Night, SDI, Victoria, Australia) (Figure 5).
After recontouring with composite resin (Amaris) and provisional restoration with bisacrylic resin (Structur 3), the ceramic color was selected from the VITA 3D Master scale.
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Temporary restorations with bisacrylic resin (Structur 3, Voco, Cuxhaven, Germany) were made on the lateral incisors (Figure 6).
Model (a) with die. Reinforced ceramic with lithium disilicate in the BL4 color. External and internal aspects of ceramics on the microdont tooth after finishing (b and c).
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The ceramic was prepared with the E.max injected system (Ivoclar Vivadent, Schaan, Liechtenstein) in the color BL4 and applied to the ceramic for intrinsic incisal characterization (Figure 7).
Removal of temporary restorations. Note the absence of soft tissue inflammation, demonstrating adequate adaptation of the provisional restorations with bisacrylic resin.
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The material used for the cementation of the ceramics on the lateral incisors was Bifix SE self-adhesive cement (Voco, Cuxhaven, Germany) in opaque white (WO) (Figure 8).
Front (a) and left (b) detail of resin restorations combined with ceramics.
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The results can be seen in Figures 9 and 10.
Frontal and lateral views of the patient's final smile. Final view of the teeth with resting lip, demonstrating improved translucency of the prosthesis over the implant.
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The results can be seen in Figures 9 and 10.