Dental Tribune Nordic Edition No. 3, 2016

Aesthetics is an aspect that plays an important role in modern den- tistry. As ever more patients desire a “perfect” smile, dentists are in- creasingly being called upon to pro- duce highly aesthetic restorations and optimise the natural situation. Reshaping of the teeth is a safe pro- cedure with a predictable result and can be routinely performed to create a more appealing and harmonious smile. However, it re- quires corresponding diagnostics and treatment planning that takes both aesthetic and functional as- pects into consideration. The em- ployment of minimally invasive techniques to preserve the tooth substance and neighbouring struc- tures and the use of dental mate- rials with the highest possible stability and biocompatibility are essential too. Restoration with in- direct composite veneers is one possible treatment. Clinical case A 20-year-old male patient wanted to improve the aesthetics of his smile (Fig. 1). Clinical exami- nation showed a diastema be- tween the maxillary central inci- sors (Fig. 2). The patient wanted a quick solution without ortho- dontic treatment. By analysing the photographs of the patient’s face, we were able to establish that the line running along the incisal edges and cusp tips of the canines of the maxillary anterior teeth did not form a regular curve. In order to attain an attractive smile, it would thus be necessary to adapt the shape of all four maxillary in- cisors in such a way that they formed a positive smile line (Fig. 3). During the lateral movements, there was no contact between the mandibular anterior teeth and maxillary incisors, allowing the possibility of lengthening them. As the patient was young, a minimally invasive technique was required, and for this reason, we decided on a procedure in which preparation of the teeth was not essential. We chose an in- direct technique with the restora- tions made from Admira Fusion (VOCO), a material containing a ceramic matrix instead of the conventional methacrylate-based monomers, making it highly bio- compatible. The use of indirect veneers produced by the dentist represents an alternative to pre- fabricated veneers. Producing the veneers oneself offers further ad- vantages, such as the low costs, the possibility of individualising the tooth shape, the reduced Fig. 1: A 20-year-old patient presented for dental treatment owing to a diastema between his maxillary central incisors.—Fig. 2: The in- tra-oral view shows the positions of the anterior teeth and their mor- phology in more detail. —Fig. 3: We established that the four maxillary incisors would need to be treated if we were to achieve a satisfactory result.—Fig. 4: As treatment, we selected the fabrication of indirect restorations on a silicone model. This has advantages over the use of prefabricated veneers, as producing them in-house allows for customisation and achievement of a better marginal seal.—Fig. 5: We selected the shade to be used during the first treatment session by applying a small quantity of the material in each of the shades to the tooth, smoothing off the surface with a large metal spatula and then curing the material. In this case, we decided on Shade A1.—Fig. 6: The restorative material (Admira Fusion) was applied directly to the finished silicone model. Spatulas were used to model the teeth in accordance with the morphology of the corresponding group of teeth. In this case, veneers were to be used to restore a proper curve to the line connecting the cusp tips of the canines and the incisal edges.—Fig. 7: After polymerisation, we removed the veneers from the model, finished them and polished them with rubber grinders and polishers for ceramic restorations.—Fig. 8: Superimposing a photograph of the finished veneers over a photograph of the patient allows us to predict the position and size of the restorations after treatment was complete.—Figs. 9–10: Try-in of the veneer on tooth #21. Note the direction of insertion. It was important to observe the direction of insertion precisely when determining the order of insertion of the restorations, as no preparation was performed. 14 Dental Tribune Nordic Edition | 3/2016 TRENDS & APPLICATIONS Minimally invasive veneer restoration with a ceramic-based restorative material A case report By Mauricio Watanabe, Brazil Fig. 11: We used no. 000 retraction cords to retract the gingival margin for all the maxillary incisors.—Fig. 12: Phosphoric acid was applied to each tooth and allowed to act for 15 seconds. The neighbouring tooth was protected with a separation strip made of polyester.—Fig. 13: Teeth #11 and 21 after etching with phosphoric acid and drying.—Fig. 14: The veneer for tooth #21. It was sand-blasted with aluminium oxide to clean the interior surface.—Fig. 15: After application of the adhesive and drying, GrandioSO Flow in Shade A1 was used.—Fig. 16: View after placement of the restoration. We also removed all excess material with a no. 5 probe prior to polymerisation.—Figs. 17 & 18: Views of the veneer restorations after completion. 1 2 3 4 5 6 7 8 9 10 11 15 12 16 13 17 14 18 123 456 78910

Dental Tribune Nordic Edition No. 3, 2016

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