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cosmetic dentistry_ beauty & science

I 37 industry report _ minimal invasive treatment I cosmeticdentistry 1_2012 In order to improve the appearance of the ca- nines and make them look like lateral incisors, we also used the press technique, but combined it with the cut-back technique. Owing to the shallowness of the preparation, a very delicate framework was required. Therefore, we chose a highly translucent ingot (IPS e.max Press HT, shade BL3) for this pur- pose. The pressed substructure was subsequently built up with IPS e.max Ceram using the conven- tional layering method (Fig. 13). If the relationship between a monolithic restoration and the support- ing dental tissue is incorrect in the anterior region, it may be difficult to adjust the shade satisfactorily. In other words, if little natural tooth structure is available for the shade adjustment, the restoration may lack sufficient brightness and it may fail alto- gether. Therefore, the aim in the case described was to remove as little tooth structure as possible. _A steady hand It is thoroughly understandable that the dental practitioner was slightly apprehensive when she openedthepacketfromthelaboratory,asthedelicate veneersweremuchthinnerthanafingernail(Figs.14 & 15). The subsequent challenge was to place these restorations precisely. The teeth, with the exception of the two permanent canines and the minimally prepareddeciduouscanines,hadnotbeenground.As aresult,therewerenoclearreferencesfortheplace- ment of the veneers. Nevertheless, the OptraStick (Ivoclar Vivadent) proved to be a useful placement tool.Thisdisposableauxiliaryaidallowedtheindivid- ual restorations to be handled without the risk of dropping or breaking them. Another important as- pect of the treatment was that the dental technician was on hand to offer invaluable advice on the posi- tioning of the restorations he had fabricated. In addition, the cementation material selected was decisive for the successful shade adaptation of the restoration. In accordance with the recommen- dations for cementing restorations that are thicker than 1.5 mm, a dual-cure adhesive luting compos- ite (Variolink II, Ivoclar Vivadent) was used to place thefacedcrowns.First,asuitablecementshadewas establishedwiththehelpofthespecialtry-inpastes. Next, the ceramic restorations were etched with hydrofluoric acid and the enamel areas were con- ventionally conditioned. Monobond Plus (Ivoclar Vivadent) was used to condition the restorations, which were subsequently placed with the adhe- sive luting composite. Furthermore, at the try-in, the flowable composite Tetric EvoFlow (Ivoclar Vivadent) was chosen to cement the eight veneers. The flowability of the product was enhanced by warming it at 37°C for 20 minutes before applica- tion. Each individual veneer was placed under the watchfuleyesofthedentaltechnicianandonlypoly- merised once it was correctly in place on the tooth. _Conclusion The subsequent working steps were carried out with the same care as cementation. Excess cement was removed completely and all the necessary checks, such as the occlusion in lateral and vertical movements, were carried out. Although aesthetics played an important part in the treatment plan, functional aspects were not ignored in any way. Even though the ceramics and cements used are by far stronger and more adaptable to natural dentition than the materials used in the past, their function has to be checked nevertheless to avoid any undesirable consequences. The effect of the restorations immediately following cementation andattheone-weekandone-monthrecallsatisfied everyone involved. The materials we had selected allowed us to offer the patient minimally invasive treatmentandhighlyaestheticresults(Figs.16&17). Editorial note: A complete list of references is available fromthepublisher. Fig. 16_View of the restorations one week after their placement. Fig. 17_Successful aesthetic results were achieved with minimally invasive treatment. Dr Monica Basile VialeMorgagniGiovanBattista,1 50134 Florence Italy Michele Temperani Via Livorno,54/2 50142 Florence Italy cosmeticdentistry _contact Fig. 16 Fig. 17