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cosmetic dentistry_ beauty & science

I 17 case report _ red-white aesthetic I cosmeticdentistry 2_2013 change anything. Even the colour was a perfect match (Fig. 20). Sufficient space was left in the approximal areas to allow the papillae to regenerate (Figs. 21–23). Wedislikelongareasofcontactthatmaketheteeth appear square. On the maxillary left side, the papil- lae were almost perfect at the try-in (Fig. 24). After that, we adjusted the surface texture and performed the glaze firing using Glaze Paste FLUO (Ivoclar Vivadent). Finally, the crowns were po- lished by hand with a diamond paste to obtain the highestplaqueresistancepossible.Forthefinishing, photographsareagreathelp.Today,capturingpho- tographs of the teeth should be common practice because, especially for a case like this, no patient has the time to sit in the laboratory for hours (Figs. 25–30). Aboutthreeweeksafterpreparation,thecrowns wereseatedwithSyntacandTetricFlowinshadeA2 (both Ivoclar Vivadent). Little black triangles were still visible between teeth 11 and 12, and 11 and 21 (Figs.31–33).Oneweeklater,weperformedthefinal fit(Figs.34–37),andwerecheckedthesituationfive months later (in October). The patient showed a grey-free smile with perfectly formed papillae in all approximal areas (Fig. 38). At a recent follow-up, a small black triangle appeared between the central incisors when the saliva was blown away (Fig. 39). _Final result Six months after the start of treatment, our pa- tient was more than satisfied with the final result (Figs. 40–42). Her request for a healthy-looking gin- giva and natural-looking crowns had been fulfilled. Itisalmostimpossibletodetectartificialdentitionin hernewsmile,evenforadentistordentaltechnician. Owing to the extraor- dinary translucency of the IPS e.max crowns, the roots receive the same amount of light that would pass through a natural tooth (Figs.43a&b).Thesofttissue is then lit up naturally and the grey gingiva is com- pletely gone. Also, it is inter- esting how well the papillae are able to regenerate (Figs. 44a & b). It may even appear that the gingival margin on PFM crowns is moving by itself to escape the metal-ion infiltration. The appearance of the papillae was improved after the all-ceramic crowns had been seated (Figs. 45a & b). Finally,itcouldbesaidthatbecauseofthedraw- backs of PFM and even zirconia we should consider using true all-ceramic crowns for such cases._ _Reference 1 P. Magne & U. Belser, Adhäsiv befestigte Keramikres- taurationen (Berlin: Quintessenz, 2002). Fig. 40a & b_Close-up image pre- and post-treatment. Fig. 41_The patient with the old PFM crowns before the treatment. Fig. 42_The patient after restoration seating. Figs. 43a & b_Close-up image of the gingival margin, showing the dark tooth necks due to blocked light (a), and the correct shade and translucency of the restorations (b). This result would not have been possible with zirconia crowns, for which subgingival preparation would have been required (no bleaching was involved). Figs. 44a & b_Regeneration of the approximal papillae immediately (a) and five months after seating of the new restorations (b). Figs. 45a & b_Gingiva before treatment (a) and five months after restoration (b). Fig. 40a Jost P.Prestin,MDT André di Mauro,DDS Die Zahnärzte am alten Park Hegaustraße 3 78315 Radolfzell Germany prestin@dzaap.de www.dzaap.de www.jostprestin.com _contact cosmeticdentistry Fig. 43b Fig. 43a Fig. 41 Fig. 42 Fig. 44a Fig. 44b Fig. 45b Fig. 45a Fig. 40b