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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 (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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