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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
anterior teeth restoration case report | 39 CAD/CAM 3 2016 cus on aspects like the importance of having a suit- able treatment plan, the possibilities currently avail- ableforthefabricationofveneers,thepotentialofthe press and CAD/CAM techniques, as well as the latest improvements made in the field of cementation. Clinical case A 31-year-old female patient presented to our office because she was dissatisfied with her anterior teeth. She complained about the malalignment of the maxillary and mandibular central incisors (Fig. 1). A detailed clinical examination established that the compositerestorationsintheseteethweredefective. Asaresultoferosion,aconsiderableamountoftooth structure had been lost. In addition, malalignment of teeth #21 and #41 was quite obvious. The treatment plan we presented to the patient in- cluded initial orthodontic treatment followed by minimal preparation of the two central incisors for two ceramic veneers. The patient was referred to an orthodontist for treatment. Unfortunately, it took morethanayearbeforeshepresentedtothepractice againandwewerequitesurprisedtofindthatthetwo central incisors had been re- stored with poorly finished di- rect composite veneers (Fig. 2). In addition to preventing any contamination of the working field,theclinicianmustaccom- plishthearduoustaskofcreat- ing an appropriate emergence profile, proper contours and contact areas, and producing a suitable micro- and mac- ro-texture, and all this within a single appointment. Many simplyunderestimatethechal- lenging nature of this type of restoration,andthiswasacase in point. Owing to the poor preparation, the composite veneers had to be removed and replaced with new ones. In this particular case, the advantages of using the indirect technique were obvious. The patientagreedtohavetwoceramicveneersmadefor her. For this purpose, impressions were taken and a master cast was produced. This working model provides the dental technician with the opportunity to evaluate the situation in detail. He or she has the time to think about possible ways of correcting the malalignment. Dentists do not have this luxury of time when they are treating a patient in the dental chair, as they have to finish the restorations as quickly as possible in or- der to prevent contamination of the treatment area and keep chair time to a minimum for the comfort of thepatient.Inthepresentcase,anotherhurdlehadto be overcome: any composite material that might have remained on the tooth structure had to be clearlyidentifiedusingtrans-illuminationwithwhite light-emitting diode light (Fig. 3) and carefully re- moved without damaging the healthy tooth struc- ture. Next, the teeth were prepared, retraction cords were placed and an impression (Virtual, Ivoclar Vivadent)wastaken(Fig.4).Thepatientwasprovided with a temporary restoration, which was made with Fig. 5: Temporary restoration. Fig. 6: Try-in of the IPS e.max Press HT A1 veneers (fabricated in the laboratory). Fig. 7: Try-in of the polished IPS Empress CAD Multi A1 veneers (fabricated in the dental office). Figs. 8a & b: Try-in of the veneers with a light try-in paste (Light+). Figs. 9a & b: Try-in of the veneers with a dark try-in paste (Warm+). Fig. 6 Fig. 7 Fig. 5 Fig. 9a Fig. 9b Fig. 8a Fig. 8b 32016