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Dental Tribune Middle East & Africa No. 4, 2016

Dental Tribune Middle East & Africa Edition | 4/2016 15 RESTORATIVE and it is difficult to differentiate be- tweenthem. The protocol is based on photo- graphs and videos that are taken during the first appointment. The analysis is performed, and eventual- lythecaseisdiscussedwiththeteam ifnecessary.Oncethepresentationis ready, the treatment plan is present- ed in a visually attractive way to the patient (Fig. 15). Finally, whether to useceramicorcompositerestorative materials is considered depending on different factors. Our philosophy is based on the minimally invasive concept. As long as we can provide the patient with the same aesthet- ics, durability and predictability of ceramics,wewillselectcomposites. In cases in which many teeth are involved, multiple diastemas are present or occlusal imbalances may jeopardise a successful outcome and major changes need to be made, our choice leans towards ceramics. Whatever approach is chosen, it is of paramount importance for the clinician to understand the ceramic and/or composite system he or she is using. In this particular clinical case, the ceramic system used was IPS e.max Press and the composite system was IPS Empress Direct (both Ivoclar Vivadent) because of its sim- plelayeringconcept,itsnatural-look- ing shades and long-lasting gloss. The correspondences between the shades of both systems make them easiertocombine. Once the treatment plan has been accepted by the patient, the treat- ment begins with preparation and demarcation in order to be as con- servative as possible (Fig. 16). Figure 17 shows the detail of the hypomin- eralised areas of the mandibular lateral incisors. The areas were exca- vatedwitharedcolouredbur(Komet Dental) and etched with phosphoric acid. ExciTE F (Ivoclar Vivadent) was usedasabondingagent,andIPSEm- press Direct Dentin A1 and Enamel A1 were placed using a novel instru- ment called OptraSculpt Pad (Ivoclar Vivadent). The maxillary teeth were prepared and impressions taken. Figure 20 shows the six veneers fabricated by master dental technician Victor Romero (Santiago, Chile). Then they were tried-in with a specially de- signed glycerine-based paste, com- ponents of the Variolink Esthetic cementation kit (Ivoclar Vivadent). Figure 21 shows how dramatic the change in value can be with this type of cement. This procedure is especially helpful when one or two veneers are seated, and the value needs to be slightly corrected in or- der to match them to the adjacent teeth.Theveneerswerethenbonded and the final result can be seen in Figure 22, where the preoperative situation is shown against the simi- lar results achieved with the digital mock-up compared with the final outcome. Figures 23 and 24 show the integration of the six maxillary ceramic veneers and the two direct composite restorations performed on the mandibular lateral incisors at the three-month follow-up. All this work was integrated from the facial perspective, as seen in Figure 25. The satisfied and spontaneous patient canbeobservedinFigure26. DrEduardoMahn,DDS,DMD,PhD,isalecturerat theUniversidaddelosAndesin Santiago,Chile. DrGustavoMahn,DDS,isalecturerat theuniversityFinisTerraeinSantiago,Chile. DrCarlosCáceres,DDS,isalecturerat UniversidaddelDesarrolloinConcepción,Chile. DrLuisBustos,DDS,isalecturerat UniversidaddelDesarrolloinConcepción,Chile. DrChristianCoachman,DMD,MDT,isinprivatepracticeinSãoPauloinBrazil. Contact:DrEduardoMahn,emahn@miuandes Fig.14 Fig.15 Fig.16 Fig.19 Fig.22 Fig.25 Fig.17 Fig.20 Fig.23 Fig.26 Fig.18 Fig.21 Fig.24 ◊Page14 Dental Tribune Middle East & Africa Edition | 4/201615

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