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| trends & applications hybrid ceramics Fig. 4: Step-by-step determination of the optimal vertical dimension. Fig. 5: Frontal view of the therapeutic splint of PMMA on the model. Fig. 6: Occlusal view of the therapeutic splint on the model. Fig. 7: The splint in the patient’s mouth. Fig. 8: Superimposition of the data Fig. 12 sets of digital moulding with and without the splint. Fig. 9: Virtual design of the individual tooth restorations using superimposed scans. Fig. 10: Occlusal view of the restorations fabricated from VITA ENAMIC on the model. Fig. 11: Frontal view of the restorations on the model. Fig. 12: Situation immediately after integration. Fig. 13 Fig. 13: Occlusal view of the maxilla. Fig. 14: End result. Preliminary treatment After the patient’s referral to our clinic, we first tried to stabilise the occlusion via a reversible correction of tooth position. The optimal length of the incisal edges, the occlusal plane, and the horizontal and vertical di- mensions were determined with a maxillary bite reg- istration in wax (Fig. 4). It was shown that, through an elevation of the vertical dimension by 8 mm, a correc- tion of the Angle Class III relationship was possible. For the long-term evaluation, a PMMA splint for permanent use was fabricated on the basis of the bite registration (Figs. 5 & 6). Ten hours after its insertion (Fig. 7), the patient reported, with tears of joy, that he was pain-free. This situation has been maintained for the wear time of two years. Material selection Only after successful elevation of the vertical dimen- sion were the permanent restorations fabricated. The objective was to preserve the healthy tooth substance through a non-invasive procedure. In order to achieve an exact fit, a restorative material that could be milled very thinly at the edges was required. Furthermore, a material with properties as close as possible to those of the natural teeth was needed. With its high durability and elasticity, as well as the possibility of adhesive bonding, VITA ENAMIC met these prerequisites. Fabrication of the definitive restorations For the precise transfer of the optimal tooth posi- tion, the digital moulding was performed once with and once without the splint. The superimposed scans 38 CAD/CAM 2 2017 Fig. 14 formed the basis for the virtual design of the mono- lithic restorations made of VITA ENAMIC (Figs. 8 & 9). After fabrication, these were characterised and pol- ished (Figs. 10 & 11). When tried in, they exhibited a high-precision fit, and the patient was very satisfied with the shade; therefore, the adhesive bonding was performed imme diately. In order to create an in visible transition to the tooth substance, pre-warmed composite filling material was used. Summary With the integration of the VITA ENAMIC restora- tions (Figs. 12–14), the patient’s self-confidence in- creased and he took up a new profession. This example shows that the non-invasive treatment concept pre- sented can achieve outstanding results, leading to a significant increase in quality of life, even in patients with extreme functional problems._ Editorial note: This article was first published in the 1/2016 issue of the digital dentistry magazine (OEMUS MEDIA AG). contact Dr Sjoerd Smeekens is a well-known specialist in the field of restorative dentistry. He runs his own practice in Beuningen in the Netherlands and can be contacted at administratie@reconstructieve- tandheelkunde.nl.