cosmetic dentistry_ beauty & science

26 I I case report _ biomimetic approach and appearance of the final restoration in the patient’smouth(Figs.6a&b).Itwasdecidedtore- contour the mesial angles of the maxillary central incisors with composite and to apply two ceramic feldspathic veneers sintered on a refractory mass to the lateral incisors. Because the patient did not agree to the recontouring of the maxillary canines, it was decided not to close the gaps between the maxillary lateral incisors and canines to main- tain the normal proportions between the central and lateral incisors. The patient is still using permanent and removable retainers The persistent primary tooth 55 was scheduled for extraction. Restoration ofallthemissing premolars was planned using implant-supported ceramic crowns. _Implant treatment CBCT was performed to evaluate the anatomical and surgical conditions, and to plan the surgical treatment. Owing to sufficient height and width of the alveolar process at the implant sites, guided bone regeneration was not required. TSIII im- plants (OSSTEM; 4 mm × 10 mm S, 3.5 mm × 10 mm M) were used in regions 14 and 24, and TSII implants (OSSTEM;3.5mm×10mmM, 3.5mm×10mmM)wereused in regions 35 and 45. How- ever, delayed implantation in region14wasperformedfour weeks after the extraction of tooth 55 (Figs. 7 & 8a–c). _Prosthodontic treatment Recontouring of the central incisors was per- formed using the direct method with GRADIA DIRECT composite (GC Europe) and a two-compo- nent adhesive system, CLEARFIL SE BOND (Kuraray Noritake). Mesial angles were recontoured using the standard Hawe celluloid matrix system (Kerr). The composite surface was prepared and polished using Sof-Lex discs (3M ESPE; Figs. 9a & b). The contours of the veneers for teeth 12 and 22 were checked again using a mock-up, and then minor adjustmentswereperformed. Using a specially trimmed sil- icone mock-up, the amount of space for the planned ceramic reconstructions was determined and the prepa- Figs. 16a & b_The maxillary and mandibular arches after prosthodontic treatment. Figs. 17a & b_The modified zirconia crown on a standard abutment—the visible subgingival part of the crown was not covered with the ceramic. Fig. 18_The modified crown screwed on to implant 14. Figs. 19a & b_Post-op situation. Fig. 20_Harmonous smile after treatment. cosmeticdentistry 4_2013 Fig. 19aFig. 18 Fig. 20 Fig. 17a Fig. 16a Fig. 17b Fig. 16b Fig. 19b