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Dental Tribune Middle East & Africa Edition No.2, 2016

Fig. 10: Enamel etching with phos- phoricacid Fig. 11: Application of a single-com- ponent adhesive(AdheseUniversal) Fig. 14:The result:The patient with the ceramic veneersinplace Fig. 12: Removal of excess composite cement Fig. 13: Light-curing with Bluephase Style polymerization lights with wa- tercooling Dental Tribune Middle East & Africa Edition | 2/2016 26 aesthetics useful for this purpose (Fig. 3). Next, the teeth were prepared, retraction cordswereplacedandanimpression (Virtual®) was taken (Fig. 4). The pa- tient was provided with a temporary restoration, which was made with a temporary crown and bridge mate- rial (Telio® CS C&B, shade A1) and cemented with a dual-curing luting composite (Telio CS Link) (Fig.5). Fabrication of the restorations Twodifferentrouteswere pursued in the fabrica- tion of the veneers. We instructed our lab tech- nician to make two ce- ramic veneers using the press technique with IPS e.max® Press (shade HT A1, stained). At the same time, we milled two ce- ramic veneers with our in-office CAD/CAM ma- chine using an IPS Em- press CAD Multi block (shade A1). The veneers made in the dental of- fice were not glazed, just polished. Figures 6 and 7 allow the results to be compared from a facial perspective. This experi- ment illustrates the es- thetic potential of modern ceramics. Both types of restorations blend in beautifullywiththeirsurroundings. The appearance of the veneers produced with the help of CAD/ CAM technology came very close to that of the manually manufactured version. Nevertheless, in the end we opted for the lab-fabricated veneers ◊Page25 Contact details Dr.EduardoMahn DirectorofClinicalResearchand theEstheticDentistryProgram UniversidaddelosAndes MonseñorÁlvarodelPortillo12455 Santiago,Chile emahn@miuandes.cl (IPS e.max Press) with the consent of the patient, since we were able to achieveaslightlybettermatchtothe neighbouring teeth by staining the restorations. Placement Figures 8 and 9 show the try-in pastes (Variolink Esthetic LC) on the prepared teeth. The most suitable composite cement was determined on the basis of two differently col- oured pastes. Two extreme options were compared: Light+ and Warm+. The difference was clearly visible when the pastes were applied. Even though the darker shade (Warm+) was very close to that of the natu- ral tooth structure and would have worked well with the veneers, we endedupchoosingthelightershade. This was a typical decision. In most cases, we tend to prefer the lighter version, since it provides a better contrast to the tooth structure and therefore renders the removal of ex- cess cement easier and faster. Before the veneers were seated, retraction cords were placed and the enamel wasetched;thedentinremainedun- etched. Adhese® Universal was used as the bond- ing agent to place the veneers (Figs 10 and 11). Then the excess luting composite was carefully removed and a glycerine gel (Liquid Strip) was applied (Fig. 12). This gel prevents the formation of an oxygen inhibi- tion layer at the margins. The luting composite was cured with two cur- ing lights (Bluephase® Style) simul- taneously and cooled with plenty of water (Fig. 13). Figure 14 shows the harmonious result produced by the lithiumdisilicateveneers. Conclusion State-of-the-art restorative materials have immense potential. Depending on the particular requirements of the patient and the indication, they allow a suitable treatment option to be found quickly and easily. The case presented here shows that highly esthetic ceramic veneers can be fab- ricated with minimal effort using in-office equipment (IPS Empress CAD). Nevertheless, pressed ceramic veneers were chosen for this patient, since they offered the possibility of applying stains, through which a very close match to the neighbour- ingteethcouldbeattained.Inprinci- ple, however, highly esthetic results canbeachievedwithbothapproach- es if the appropriate treatment pro- tocolisfollowed. The article was republished with per- missionofReflectMagazine.

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