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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
| case report anterior teeth restoration 38 CAD/CAM 3 2016 Two approaches, one goal Author: Dr Eduardo Mahn, Chile In the restoration of anterior teeth, clinicians have toselectthemostappropriatematerialforthecaseat hand on the basis of specific criteria. Recently devel- oped restorative materials have opened up a myriad of exciting possibilities. In situations in which teeth show signs of erosion, abrasion, abfraction or a com- bination of these phenomena, practitioners will tend towardsusingceramicsorcompositeresins,depend- ing on how much intact tooth structure remains. Traditionally, composites are used for Class III, IV and V defects; however, ceramic veneers are preferred in cases in which a large amount of tooth structure is missing or a major change is planned (e.g. a smile makeover). When two central incisors need aesthetic enhancement, the choice of approach is not as clear. Irrespectiveofthematerialused,aminimallyinvasive approachinvolvingverylittlepreparationofthetooth structure can be taken nowadays owing to the high strength of modern materials (e.g. lithium disilicate glass-ceramic). Nevertheless, it is important to re- memberthatminimalpreparationisanoptiononlyif the teeth are properly aligned. As long as the desired changes to the tooth shape and shade are small, the preparation can be limited to the enamel. In many cases, however, orthodontic treatment is needed be- forethetoothpositionand/orshapecanbeoptimised by means of restorative procedures. This minimally invasive approach requires the dental practitioner to convince the patient of the necessity of undergoing preliminary orthodontic treatment. It is our aim to remove as little of the tooth structure as possible in every case that we treat. With modern materials such as lithium disilicate and leucite- reinforcedceramics,wecanpressormillveneersthat are as thin as 0.6 mm and even 0.3 mm with confi- dence. Only a few years ago, treatment with indirect restorations still required at least two appointments. Ceramic materials such as IPS Empress CAD (Ivoclar Vivadent) allow clinicians to produce polychromatic monolithic veneers and crowns in less than one hour andwithouthavingtoglazethem.Nonetheless,many dentistsstillbelievethatdentaltechnicianswiththeir well-honed manual skills pro- duce better aesthetic results than a machine does, and they do not see the need to embrace digital technology. As a result, somecliniciansarereluctantto invest in this technology be- cause of the high acquisition costs of the milling machines. Through the clinical case study presented here, we want to fo- Fig. 3 Fig. 4 Fig. 1: Initial situation. Fig. 2: When the patient returned to the practice after a year, her teeth showed unsatisfactory composite veneers. Fig. 3: The old veneers were removed and the teeth were transilluminated to identify any composite residue. Fig. 4: The two-cord technique was used for the impression. The retraction cords remained in the sulcus. Fig. 1 Fig. 2 32016