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ePaper created 2016-10-04, 09:33:57 | version 1.38.0
| case report anterior teeth restoration 40 CAD/CAM 3 2016 atemporarycrownandbridgematerial(TelioCSC&B, Shade A1; Ivoclar Vivadent) and cemented with a dual-curing luting composite (Telio CS Link, Ivoclar Vivadent; Fig. 5). We followed two different routes in fabricating the veneers. We instructed our laboratory technician to make two ceramic veneers using the press technique with IPS e.max Press (Shade HT A1, stained; Ivoclar Vivadent), and we milled two ce- ramic veneers with our in-office CAD/CAM machine using an IPS Empress CAD Multi block (Shade A1; Ivoclar Vivadent) at the same time. The veneers made in the dental office were just polished and not glazed. Figures 6 & 7 allowed us to compare the results from a facial perspective. This experiment illustrated the aesthetic potential of modern ceramics. Both types of restorations blended in beautifully with their surroundings. The appearance of the veneersproducedusingCAD/CAMtechnol- ogycameveryclosetothatofthemanually manufactured version. Nevertheless, in the end,weoptedforthelaboratory-fabricated veneerswiththeconsentofthepatient,sincewewere able to achieve a slightly better match to the neigh- bouring teeth by staining the restorations. Figures8&9showthetry-inpastes(VariolinkEsthetic LC, Ivoclar Vivadent) on the prepared teeth. The most suitable composite cement shade was determined on the basis of two differently coloured pastes. With Light+ and Warm+, two extreme options were compared.Thedifferencewasclearlyvisiblewhenthe pastes were applied. Even though the darker shade (Warm+) was very close to that of the natural tooth structure and would have worked well with the veneers, we selected the lighter shade. This is very common, as in most cases we tend to prefer the lighter version because it provides a better contrast to the tooth structure and therefore ren- ders the removal of excess cement easier and faster. Beforetheveneerswereseated, retraction cords were placed andtheenamelwasetched(not the dentine; Fig. 10). Adhese Universal (Ivoclar Vivadent) was used as the bonding agent to place the veneers (Fig. 11). The excess luting composite was then carefully removed (Fig. 12) and a glycerine gel (Liquid Strip, Ivoclar Vivadent) was applied. This gel prevents the formation of an oxygen inhibition layer at the margins. The luting composite was cured with two curing lights (Bluephase Style, Ivoclar Vivadent) simultaneously and cooled with plenty of water(Fig.13).Figure14showstheharmoniousresult produced by the lithium disilicate veneers. Conclusion State-of-the-artrestorativematerialshaveimmense potential. Depending on the particular requirements ofthepatientandtheindication,theyallowasuitable treatmentoptiontobedeterminedquicklyandeasily. The case presented here shows that highly aesthetic ceramic veneers can be fabricated with minimal effort using in-office equipment (IPS Empress CAD Multi). Nevertheless, pressed ceramic veneers were chosen for this patient, since they offered the possi- bility of applying stains, through which a very close match to the neighbouring teeth could be attained. As a principle, however, highly aesthetic results can be achieved with both approaches if the appropriate treatment protocol is followed._ contact Dr Eduardo Mahn is the director of clinical research and of the aesthetic dentistry programme at the Universidad de los Andes in Santiago in Chile. He can be contacted at emahn@miuandes.cl. Fig. 10: Enamel etching with phosphoric acid. Fig. 11: Application of a single-com- ponent adhesive (Adhese Universal). Fig. 12: Removal of excess composite cement. Fig. 13: Light curing with Bluephase Style polymerisation lights. Fig. 14: The patient with the new ceramic veneers. Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 32016