cosmetic dentistry_ beauty & science International Edition

case report _ ceramic veneers I Analysisofwhiteandredaesthetics The incisal edges of the maxillary incisors were not visible with the lips in rest position. There was a reverse smile line. The gingival margin of the maxillary incisors and canines was unbalanced (Figs. 8a & b). Analysisofocclusionandarticulation A slight tenderness of the masseter muscles and medial pterygoid muscles was observed. There were no audible symptoms during abduc- tion and adduction, or during lateral movements. Mandibular movements were within the normal range. During load testing of the mandible according to Dawson’s technique, no pain was observed. There was generalised abrasion of the teeth in both the maxillae and the mandible. No evident points of first contact in CR were present. There were enamel defects on the ves- tibular surfaces of the maxillary incisors. Initially, bruxism was diagnosed without lesions in the temporomandibular joint. Treatmentplan An increase in the height of occlusion in CR, a correction of the gingival margin in the an- terior zone, and feldspathic ceramic veneers for the maxillary canines and incisors were planned. CR registration was performed with Dawson’s techniqueusingawaxplate(BiteRegistrationWax wafer, DeLar) after 15-minute deprogramming by means of a deprogrammer (Lucia Jig) with a flat surface on the incisors and no contact between the lateral teeth. Facial arch registration was per- formed and the models were placed in a partially adjustable Artex articulator. A diagnostic wax-up was made, partly reconstructing the worn tissue of the lateral teeth. Incisal and canine guidance was obtained in the anterior section. On the basis of the wax-up, a mock-up was made in the pa- tient’s mouth to obtain acceptance of the shape andlengthoftheincisorsandcanines,andtocheck the function (Figs. 9a & b). Occlusal conditions planned on models were reconstructed in the patient’s mouth with tem- porary restorations retained for a period of four weeks, and adjustments to occlusion and lateral movements at weekly intervals. After the adaptation period, the temporary restorations were replaced with final ones. Pressed ceramic onlays, crowns with a zirconium dioxide core and direct composite restorations were fabri- cated for the posterior section. Adjustments to the gingival margin of the maxillary incisors and canines were done with a #15 scalpel blade (Figs. 10a & b) and the effect was maintained by appropriate shaping of the temporary re - storations. Two weeks after correction of the gingival mar- gin, the final preparation for feldspathic ceramic veneers on the maxillary incisors and canines was performed. The preparation was carried out with a red-coated drill in the shape of a rounded cylin- der, followed by smoothing with fine Sof-Lex discs (Fig. 11). The preparation was limited to the re- moval of old composite restorations of Black’s Class V, and to smoothing the facial surface and the incisal edges. Fig. 20_Drawing of preparation lines. Fig. 21_Coating with a ceramic. Fig. 22_Baking of the ceramic layers. Fig. 23_Subsequent ceramic layers. Fig. 24_Finished crowns, veneer side view. Fig. 25_Finished crowns, palate side view. (Ceramics performed by Dorota Michalik.) I 23cosmeticdentistry 1_2014 Fig. 25Fig. 24Fig. 23 Fig. 22Fig. 21Fig. 20 CDE0114_18-25_Michalik 11.06.14 14:05 Seite 6