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Dental Tribune Middle East & Africa Edition No. 3 2015

14 Dental Tribune Middle East & Africa Edition | May-June 2015restorative Advancing the future of education Hamdan Bin Mohammed College of Dental Medicine, an institution of the Mohammed Bin Rashid Academic Medical Center, is a dental institution launched to support the community with the finest quality of dental education. The postgraduate college offers residents a three year Master of Science Degree in the following six specialisations: • Endodontics • Oral Surgery • Orthodontics • Paediatric Dentistry • Periodontology • Prosthodontics For more information on admissions, please call the Student Affairs Office at +971 4 424 8612 or visit our website at www.hbmcdm.ac.ae. * Applies within the United Arab Emirates only. HAMDAN BIN MOHAMMED COLLEGE OF DENTAL MEDICINE Phone +971 4 424 8777 | Fax +971 4 424 8686 P.O. Box 505097, Dubai Healthcare City, Dubai, United Arab Emirates 800-DENTAL * FORMORE INFORMATION CALLUSON www.hbmcdm.ac.ae > Page 16 Impeccable esthetic results with ceramic restorations By Dr. Nelson Geovane Mass- ing, Brazil, Passo Fundo, Brazil, and Alexandre Santos, Brazil T he aim of any restora- tive treatment in ante- rior teeth is to re-establish proper function and a natural- looking smile. In addition to en- suring the function and longev- ity of the restoration, the esthetic expectations of the patient have to be fulfilled. Materials that are based on bio- mimetic principles allow the natural teeth to be faithfully reproduced in many different clinical situations. Furthermore, biomechanical aspects and light-optical characteristics have to be taken into consideration in the restoration process. Clinical case study The 33-year-old patient request- ed an esthetic makeover for his front teeth. The slight gap (dias- tema) in the upper anterior den- tition, which was visible when he smiled, displeased him in particular. The clinical exami- nation also revealed dark stains on tooth 21, which had been caused by endodontic treatment and composite restorations (Figs 1 and 2). Models were created and photos taken in order to thoroughly analyze the existing situation and plan the antici- pated result. The photographic documentation included portrait pictures of the patient as well as intraoral close-ups. Subsequently, the tooth shade (Fig. 3) was determined. The Digital Smile Design protocol was used and a wax-up was fashioned on the basis of the in- formation acquired during the planning stage. A composite res- in (Systemp® C&B) was used to fabricate an intraoral mock-up of the planned restorations. Selection of the restorative material A suitable restorative system was chosen on the basis of general esthetic and functional considerations. In the following case, we decided to take advan- tage of the outstanding esthetic potential of feldspathic ceramic and the excellent biomechani- cal performance of the adhesive cementation protocol on natural tooth structure. State-of-the-art adhesive luting techniques involving ceramic conditioning with hydrofluoric acid and silane produce reliable bonds between ceramic restora- tions and natural dentition. Moreover, adhesive cementa- tion requires less invasive prep- aration of the tooth structure and it imparts the restoration with excellent biomechanical properties. Preparation and impression taking Fig. 1. Preoperative smile: The patient was dissatisfied with the a 12 lignment of his front teeth. Fig. 4. After minimally invasive preparation of teeth 12 to 22 Fig. 5. Custom-layered veneers in the laboratory on refractory dies Fig. 6: The veneers were made of fluorapatite leu- cite glass-ceramic (IPS d.SIGN). As a result, light- optical qualities that are similar to those of natural teeth were achieved. Fig. 2. Close-up: Slight gaps are visible between the front teeth, and tooth 21 is discoloured. Fig. 3. Determination of the tooth shade Fig. 7. The delicate ceramic veneers were prepared for seating. Fig. 8: The fit of the individual ve- neers was checked in the mouth of the patient. As a result of sophisticated de- velopments in dental ceramics and adhesive dentistry, it is now possible to fabricate delicate, ultra-thin restorations showing outstanding translucent proper- ties. In the present case, teeth 12, 11, 21 and 22 were prepared to receive veneers. Since tooth 11 showed some discolouration, more tooth structure was re- moved from it during prepara- tion (removal of approximately 1 mm of tooth structure; Fig. 4). The other three teeth required only minimal preparation. The canines 13 and 23 remained untouched, since they were to be restored with veneers that do not require any preparation. A silicone matrix made accord- ing to the diagnostic wax-up was used as an orientation aid dur- ing preparation. Tooth prepara- tion was confined to the dental enamel in order to ensure an effective and long-lasting adhe- sive bond. The impression was taken with an addition silicone (Virtual®) using the double-cord tech- nique. Subsequently, the pre- pared teeth were photographed together with the shade guide samples in order to ensure the best possible shade match in collaboration with the dental laboratory. The matrix which had been fabricated according to the diagnostic wax-up was used to produce the intraoral mock-up. The composite mate- rial (Systemp C&B) was used for this purpose and for fashioning the provisional restoration. at +97144248612 or visit our website at www.hbmcdm.ac.ae. Phone +97144248777 | Fax +97144248686

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