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12 Dental Tribune Asia Pacific Edition | 9/2016 TRENDS & APPLICATIONS Resin-bonded single-tooth glass- ceramic restorations such as veneers and onlays have been routinely used for many years in dentistry. Nonetheless, their use for complex rehabilitations such as in patients with generalised hard- tissue defects, for example, is still much debated. These concerns are increasingly being resolved in view of the beneficial preliminary results reported in controlled clinical stud- ies and the experiences gained in specialist practices. It is essential for the long-term and reliable application of this method to accurately coordinate the stages between the dentist and technician and allow the patient to be actively involved. These stages consist of a careful treat- ment planning process, including a study wax-up/mock-up (aes- thetic evaluation); an adequate pretreatment phase, including a functional evaluation; selection of the correct materials, combined with a preparation and placement technique appropriate for the materials selected; and imple- mentation of an adequate occlusal design. This case report first de- scribes the use of glass-ceramic restorations for the complex reha- bilitation of a patient with exten- sive loss of tooth structure and then evaluates the restorations after they have been in situ for more than 11 years. Clinical situation and treatment A 40-year-old female pre- sented at the practice requesting restoration of her dentition, which was severely worn. She said that she had begun to experience in- creased sensitivity to thermal and chemical stimuli and complained about the unfavourable aesthetic appearance of her teeth (Fig. 1). When we recorded her dental history, she told us that she had become aware of an untoward change in her anterior teeth and in the fullness of her lips, particu- larly evident in photographs of herself. The clinical findings and dental history showed large and, at times, extensive destruction of her tooth structure, as well as extensive changes in the propor- tions of her teeth. These changes were primarily caused by abrasive processes and had resulted in a re- duction of the vertical dimension of occlusion (VDO). A functional analysis of the dentition did not reveal anything unusual. However, the loss of ca- nine guidance and the emergence of anterior and posterior group guidance were conspicuous (Figs. 2a & b). The particular challenges we had to overcome in her case were the high complexity of the rehabilitation, the patient’s re- quest for a prompt and minimally invasive improvement of her situ- ation, the need for creating an appropriate tooth morphology and therefore for reconstructing the VDO, as well as the permanent placement of the restorations on damaged tooth structure. Long-term documentation of an 11-year old restoration A case of complex aesthetic and functional rehabilitation using glass-ceramic materials By Prof. Daniel Edelhoff and Oliver Brix, Germany 1 2a 2b 3a 3b 4 Fig. 1: Pre-op situation shows a severely affected aesthetic appearance owing to a loss of the VDO and the formation of a reverse smile line resulting from an extensive loss of tooth structure.—Fig. 2a: Lateral view from the left during dynamic occlusion: traumatic contacts during functional movements had led to extensive loss of enamel and exposure of dentine.—Fig. 2b: Lateral view from the right during dynamic occlusion: loss of canine guidance and severe destruction of maxillary and mandibular anterior teeth.—Fig. 3a: Frontal view at protrusion: traumatic contacts had led to substantial changes in the morphology of the teeth.—Fig. 3b: Frontal view at protrusion after the restoration: the function and aesthetics of the dental morphology had been restored.—Fig. 4: Onlays made of leucite-reinforced glass-ceramic (IPS Empress Esthetic). The minimum layer thickness of the occlusal surface was 1.5 mm. 7a 7b 7c 5 6a 6b Fig. 5: Adhesive placement of the restorations in the mandible using the total-etch technique and rubber dam isolation.—Fig. 6a: Onlays on teeth #34–37 after adhesive cementation in 2004 (cf. Fig. 4).— Fig. 6b: Onlays on teeth #34–37. The photographs were taken in the summer of 2015 after having been in situ for 11 years (cf. Fig. 6a).—Fig. 7a: Pre-op situation: mandibular anterior teeth showing substantial changes in proportion and exposure of dentine owing to a reduction in VDO.—Fig. 7b: Layered veneers (IPS d.SIGN) in the mandibular anterior region after adhesive cementation.—Fig. 7c: The mandibular veneers in 2015. A severe wear facet had formed on tooth #43 over the course of the 11 years since the veneers were placed (cf. Fig. 8b).