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Dental Tribune Middle East & Africa Edition

8 Dental Tribune Middle East & Africa Edition | November-December 2014clinical The aesthetic challenge Figure 1 Figure 5 Figure 2 Figure 6 Figure 9 Figure 10 Figure 11 Figure 3 Figure 7 Figure 4 Figure 8 > Page 30 By Dr. Mohamed El Sayed Hassanien, Egypt P atient’s satisfaction has al- ways been the main goal achievement of dental professionals particularly with esthetics. As the popularity of esthetic dentistry increases, a growing number of patients are seeking treatment for improve- ment of unaesthetic anterior dentition. Accordingly several treatment options have been proposed to restore the pleasant esthetic ap- pearance that the patients are always seeking. Based on the conservative ap- proach and minimal invasive dentistry protocols, ceramic laminate veneers have been in- troduced to satisfy the patients growing esthetic demands. Many construction techniques have been utilized in the dental market whether directly or in di- rectly to fabricate ceramic lami- nate veneers. CAD/CAM being state of the art dental technology offers lots of merits for both the clinician and the patient. Being a chair side same day procedure, utiliz- ing intra oral scanning avoiding conventional physical impres- sions, and long-term provisional restorations thus producing an esthetic all-ceramic restoration with highest degrees of accuracy and precision. Case presentation A twelve year girl, medically healthy, denies taking any medi- cations visited my clinic com- plaining of fractured upper two central incisors Fig. 1 & 2. After clinical and radiographic exami- nation, which revealed complete root formation, two ceramic ve- neers for both central incisors were proposed as a treatment option to solve her complaint. Tooth preparation Tooth preparations were made using the depth-guided dia- mond wheel no. 018 to indicate the facial reduction amount of 0.4 mm for both teeth. The labial diamond bur no. 016 was used to complete the preparation on the labial surface and precisely re- produce the cervical finish line located just below the free gingi- val margin Fig. 3. Incisal preparations were made with type two-veneer prepara- tion design ending with a butt joint on the Incisal edge and not involving the palatal wrap around. Finally finishing bur no. 014 was used to finish and smooth all the preparation surfaces Fig. 4. All teeth preparations were made with loupes of magnifica- tion 2.5 X for better precision. CAD/CAM fabrication steps In lab SW 4.2.3 was used to scan, design and mill these two ve- neers. The case was administrated as two veneers on tooth number 8 and 9; with the bio-generic indi- vidual design technique, materi- als were selected from Ivoclar Vivadent Empress Cad Fig.5. Intra oral scanning Sirona Omnicam was used to scan the upper, lower and buc- cal catalogues to formulate the 3D virtual colored model. Mar- gins were determined for each tooth separately and insertion axis were determined depend- ing on their corresponding path of insertion. Virtual design The virtual design was proposed with the SW, both veneers were virtually linked as a group so they were both virtually active. The bio generic variation tool was used to give the best mor- phological proposal to match with the adjacent teeth. The Grid tool was used to show the veneers proportions to ensure that the two veneers showed similar length to width relations Fig.6. With the two veneers linked, res- toration virtual translucency tool was used to check the amount of ceramic extension in relation to the underlying tooth preparation Fig.7. SW 4.2 showed a new colored model tool, which enables the operator to see both veneers with the same color match for more valid size comparison Fig.8. Shade matching Visual shade matching was used for this case. Where the adjacent sound teeth showed A1 shade. Empress Cad blocks being a Lucite reinforced ceramic ma- terial was chosen for this case with a low translucency in order to mimic the adjacent shade of the teeth. Try in stage was done for the patient before glazing to check for proper seating and ac- curacy of the margins. Glazing and characterization Both veneers were seated prop- erly with the object to fix putty material for better handling dur- ing glaze and stain process. Empress Cad paste glaze was the material of choice for glaz- ing the two veneers. In order to match the adjacent teeth, Em- press Cad white stain was used on the middle and Incisal areas in a scattered pattern with a thin brush to give the natural white stain effect. Single cycle was used for staining and glazing to- gether Fig.9 Cementation procedures • Ceramic veneer surface treat- ment: HF 4 % Empress etching gel was

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