Dental Tribune Nordic Edition No. 3, 2016

thickness of the cement layer and the improved marginal seal. The use of a mock-up, the basis for which was produced in this case with die silicone (VOCO) (Fig. 4), is advantageous for the simple and quick fabrication of indirect restorations. The matching shade for the restorative material was selected during the first treatment session. This was done by applying a small quantity of each of the possible shades to the vestibular surface of one of the teeth to be restored and curing it. After com- paring the shades, we decided on Shade A1 (Fig. 5). The restorative material was applied to the silicone model with a metal spatula for fabrication of the actual mock-up and thus also for the veneers (Fig. 6). During this step, it is important to adhere to the planning specifications deter- mined based on the photograph analysis. The aim was therefore to lengthen the maxillary incisors. Light curing was followed by fin- ishing and polishing with rubber polishers (Fig. 7). We then photo- graphed the model and super- imposed the image over a photo- graph of the patient smiling in order to check whether the size and alignment of the teeth were correct (Fig. 8). The veneers were adapted directly to the patient’s teeth (Figs. 9 & 10). A considerable advantage of this technique is the possibility of checking whether the result will satisfy expectations before the treatment is completed. Try- ing in the restorations allows the patient to see the result and re- quest any changes. Once the mar- ginal seal had been checked and the patient was happy with the aesthetics achieved, preparations were made for placing the indirect veneers. We chose the adhesive Futurabond U (VOCO) in combina- tion with the flowable composite GrandioSO Flow (VOCO) in Shade A1 for luting. The gingival margin was re- tracted with a no. 000 retraction cord (Fig. 11) and 37 % phosphoric acid applied to the teeth for 15 sec- onds (Fig. 12). After rinsing with water and drying of the etched vestibular surfaces (Fig. 13), the adhesive was applied, the solvent dried with an airstream and light curing performed for 10 seconds. The interior surfaces of the ve- neers were sand-blasted with alu- minium oxide (90 µm) at a pres- sure of 60 psi in order to clean and roughen the surface. The homo- geneous, clean surface of the in- terior of the veneer was evident when viewed against the light (Fig. 14). In the next step, the adhesive was applied to the same surface and then dried with a light air- stream. A small quantity of flowa- ble composite was then distrib- uted on the surface (Fig. 15) and the veneer placed on the correspond- ing tooth (Fig. 16). After applica- tion, the excess composite was removed and light polymerisation was then performed. Once all of the veneers were in position, the restoration margins were finished with a no. 15C scalpel and polished with rubber polish- ers. We assessed the results im- mediately upon completion (Figs. 17 & 18). Corresponding grinding was carried out to ensure even contact between the mandibular incisors and maxillary central in- cisors during protrusive move- ments (Fig. 19). Grinding was also employed to eliminate all contact between the veneers and the man- dibular teeth during lateral move- ments (Figs. 20 & 21). Views of the vestibular and palatal aspects under indirect light revealed that the details had been well finished and that the indirect restorations blended harmoniously with the neigh- bouring structures (Figs. 22–25). A comparison of the pre- and postoperative views showed a clear improvement of the tooth aesthetics and the positive effect this had on the patient’s smile (Figs. 26 & 27). 15 Dental Tribune Nordic Edition | 3/2016 TRENDS & APPLICATIONS Mauricio Watanabe is an expert in the treatment of gingival dis- ease and maxil- lofacial surgery and is a practis- ing dentist in São Paulo in Brazil. He is currently studying towards a doctor- ate in biomaterials at Universidade Estadual Paulista in Araçatuba. He can be contacted at mauriciowatanabe@ yahoo.com.br. Fig. 19: Contact between the anterior teeth during protrusive movements.—Figs. 20 & 21: After grinding of the veneers, there was no further contact between the anterior teeth during lateral movements.—Figs. 22 & 23: Images of the veneers under indirect light. The details are clearly visible.—Figs. 24 & 25: View of the vestibular and palatal aspects of the anterior teeth with a harmonious curve.—Figs. 26 & 27: A comparison of the patient’s before and after smile. Be confident through life ENGLISH World Oral Health Day 20 March Good oral hygiene habits, avoiding risk factors and having a regular dental check-up from early in life can help maintain optimal oral health into old age. Visit the website to find out how to Live Mouth Smart. www.worldoralhealthday.org Join us for World Oral Health Day 2017! 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Dental Tribune Nordic Edition No. 3, 2016

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