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11 Dental Tribune Nordic Edition | 4/2016 TRENDS & APPLICATIONS imposed on the prepared teeth to demonstrate the minimally inva- sive and additive character of the procedure. Conventional impres- sions were taken of the situation and sent to the dental laboratory (Figs. 7a & b). Models were fabricated and digitised with a laboratory scanner (S600 ARTI, Zirkonzahn). The preparation shade was deter- mined in the laboratory in order to properly establish the individual tooth shades. This is particularly important when all-ceramics are used, since the preparation shade considerably influences the optical properties of these materials. The provisional restorations were fabricated using CAD/CAM technology. The crowns, veneers and onlays were adjusted to the prepared situation in the digital mock-up and then milled to full contour using a tooth-coloured PMMA material (Fig. 8). The fit of the restorations was checked on the model. The provisionals were then polished and cemented in place with a temporary luting composite. The functional and aes- thetic factors were checked in the mouth. During the following eight weeks, the patient was able to test the new situation and the raised vertical dimension (Fig. 9). At this stage, it was still possible to modify the restorations without any dif- ficulty. However, the patient had accustomed himself to the new vertical dimension very quickly and without any complications. Fabrication of the all-ceramic restorations The permanent restorations were fabricated with the help of the mock-up data. On the basis of the initial facial scan, the crowns, onlays and veneers were con- structed in accordance with the mock-up (Fig. 10). Up to this part of the procedure, all the work had been done using digital means, without a conventional wax-up. This changed when the individual ceramic restorations, especially the veneers, were produced, since their aesthetic design required considerable manual skill. In the present case, the plan was to obtain the desired func- tional and aesthetic results with the press technique. For this purpose, the computer designed- restorations were machined in wax inafive-axismillingunit(M5Heavy Metal Milling Unit, Zirkonzahn) and subsequently pressed with the IPS e.max lithium disilicate glass-ceramic (Ivoclar Vivadent; Fig. 11). The maxillary anterior res- torations were cut back and then imparted with lifelike characteris- tics and play of colour. The crowns pressed with low-translucency ingots in Shade A1 were reduced and then the incisal areas were built up with veneering ceramic (IPSe.maxCeram,IvoclarVivadent). The pressed monolithic veneers for the mandibular anterior teeth, aswellastheonlaysandthecrowns for the posterior teeth, showed adequate aesthetics (medium- translucency ingots in Shade A1). These monolithic restorations were polished to a high gloss and then individualised with stains (IPS e.max Shades/Essence and Glaze, Ivoclar Vivadent). On the model, theall-ceramicrestorationslooked very natural in terms of their colour and shape (Fig. 12). Adhesive cementation In preparation for their place- ment, the inner surfaces of the in- dividual ceramic restorations were conditioned and etched with a 4.9% hydrofluoric acid (IPS Ceramic Etching Gel, Ivoclar Vivadent) for 20 seconds. The clean, prepared teeth were conditioned with the Syntac classic system (Ivoclar Vivadent), which comprises a primer,anadhesiveandHeliobond. The lithium disilicate glass-ce- ramic restorations were adhesively bonded with a dual-curing luting composite (Variolink Esthetic DC, Ivoclar Vivadent) in accordance with the manufacturer’s instruc- tions (Fig. 13). The restorations showed excellent marginal adapta- tion after their adhesive cementa- tion. The transitions to the natural tooth structure were virtually in- visible. In terms of their shape and function, the restorations fully corresponded to the result realised with the help of the provisional res- torations (Figs. 14a–16). The perma- nent restorations were fabricated using CAD/CAM technology and the press technique. The thin, defect-oriented individual restora- tions provided an aesthetic, func- tional and reliable solution for re- storing the dentition. Conclusion Digital technology—in the form of a face scanner, for example—is of immense help in the treatment planning process. The minimally invasive approach used in this case is easy to implement with the help of CAD/CAM fabrication methods. The creation of a virtual wax-up, a CAD/CAM mock-up, provisionals and wax models for pressing the lithium disilicate restorations all contributed to achieving a predictable, aesthetic, cost-effective and efficient result. The intra-oral photographs taken three months after the treatment show the stable occlusion and the excellent condition of the perio- dontal tissue. This case report was the winning entry in the Europe, Middle East and Africa category of the IPS e.max Smile Award 2016. It was first published in the REFLECT magazine, 3/2016. Prof. Petra Gierthmühlen is Director of theDepartment of Prosthodon- tics at the Düs- seldorf Univer- sity Hospital in Germany. She can be contacted at petra.gierthmuehlen@med.uni- duesseldorf.de. Udo Plaster is a master dental technician and runs his own dental labora- tory in Nurem- berg in Germany. He can be con- tacted at info@plasterdental.de. Fig. 13: Preparation for the adhesive cementation.—Figs. 14a–15b: Photographic documentation of the result: the function and aesthetics of the teeth completely fulfilled the requirements of the patient.—Fig. 16: The happy patient. www.dental-tribune.com The Dental Tribune International Magazines Shipping Address Name Address Zip Code, City Country E-mail Date, Signature PayPal Credit Card Credit Card Number Expiration Date Security Code CAD/CAM Clinical Masters* cosmetic dentistry** implants laser ortho** roots Journal of Oral Science & Rehabilitation*** Fax: +49 341 48474 173 E-mail: subscriptions@dental-tribune.com EUR 44 per year (4 issues per year; incl. shipping and VAT for customers in Germany) and EUR 46 per year (4 issues per year; incl. shipping for customers outside Germany). * EUR 12 per year (1 issue per year; incl. shipping and VAT for customers in Germany) and EUR 14 per year (1 issue per year; incl. shipping for customers outside Germany). ** EUR 22 per year (2 issues per year; incl. shipping and VAT for customers in Germany) and EUR 23 per year (2 issues per year; incl. shipping for customers outside Germany). *** EUR 200 per year (4 issues per year; incl. shipping and VAT). 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