cosmetic dentistry_ beauty & science

28 I I case report _ biomimetic approach gel to prevent oxygen access and the formation of an oxygen inhibition layer on the composite bond. Curing was continued with an 800 mW/cm2 polymerisation lamp for 60 seconds on each sur- face. Excess composite was removed with a #12 scalpel blade, and the veneers were polished with strips and rubber polishing burs for composites. Finally, the veneers were checked during occlu- sion and articulation using 14 µm articulating pa- per. Corrections were made using a 45 µm smooth diamond-coated bur on a 1:5 speed-increasing handpiece on a micromotor. The final polishing was performed using rubber burs for composites (Figs. 11a & b). After a week, gingival integration with the veneers had been achieved (Figs. 12a & b, 13 a–d). After a period of healing, the emergence profile of the implant restorations was reshaped using crowns on temporary abutments (Figs. 14a & b). After obtaining a satisfactory effect for implants 24,35and45,permanentzirconiacrownsonstan- dardzirconiaabutmentswerefabricated(Figs.14c &d,15a–c,16a&b).Owingtothethicklayerofsoft tissue, a modified screw-retained zirconia crown on a zirconia abutment was placed on implant 14 (Figs.17a&b).Theemergenceprofilewasreshaped using a crown bonded to the standard zirconia abutment and the crown was veneered with feldspathic ceramics only at the supragingival zone, owing to the unavailability of individually shapedzirconiaabutmentsfortheOSSTEMsystem (Fig. 18). _Conclusion Working with patients missing so many perma- nent teeth is extremely difficult and sometimes markedwithcompromise.Achievingasatisfactory result both functionally and aesthetically is possi- bleonlythroughthecloseco-operationofspecial- istsfromvariousfieldsofdentistryandmeticulous planning from the commencement of treatment to the final aesthetic stage (Figs. 19a & b, 20). As I mentioned at the beginning, apart from other crucial issues, it is important to preserve the pa- tient’s own tissue as far as possible, which trans- lates into the longevity and stability of the re- storations. The case presented demonstrates that. We achieved satisfactory long-term aesthetic and functional results with minimum intervention. After two years, there is perfect bone stability around the implants (Fig. 21a–d) and excellent gingival integration with the prostheses on both the implants and the natural teeth (Figs. 22a & b, 23a–d, 24)._ Fig. 24_Pantomographic X-ray two years after implants loading, perfect bone stability. cosmeticdentistry 4_2013 Dr Magdalena Jaszczak- Małkowska (DMD) graduated from the Medical University ofWarsaw in Poland in 1996. Until 1998,she was a collaborator with the Institute of Genetics andAnimal Breeding of the Polish Academy of Sciences.In 2008,she obtained a certificate in Prosthodontics.She has worked in a private practice specialising in aesthetic and prosthodontic dentistry since 2000. ESTEDENTICA ul.Dobra 27/A,00-344Warsaw,Poland m.jaszczak@estedentica.pl Dr Joanna Witanowska (DMD) graduated from the Medical University ofWarsaw.She is a specialist in orthodontics and a research fellow at the Department of Orthodontics at the University. She is completing a doctoral thesis in Orthodontics. ul.Nowogrodzka 59,02-005Warsaw,Poland jwitanowska@gmail.com Dr Małgorzata Zadurska (DMD,PhD) graduated from the Poznan University of Medical Sciences in Poland.She is a specialist in orthodontics and paediatric dentistry,andAssociate Professor at and head of the Department of Orthodontics at the Medical University ofWarsaw. Nowogrodzka 59,02-005Warsaw,Poland cosmeticdentistry _about the authors Fig. 24