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14 TRENDS & APPLICATIONS Dental Tribune Asia Pacific Edition | 6/2017 trix made of silicone putty was used as an auxiliary. The shade match of the chosen composite and the IPS e.max ceramic was deemed ideal. A rubber dam was used for isolation (Op- traDam Plus, Ivoclar Vivadent). A composite stratification tech- nique was used to build up the incisors (Figs. 10a–s ). The enamel was slightly roughened, etched (37 % phosphoric acid, 15 sec- onds, total etch) and then coated with a light-curing adhesive (Adhese Universal, Ivoclar Vivadent). The adhesive was scrubbed into the bonding sur- face and then light cured (Blue- phase Style, Ivoclar Vivadent). First, the palatal enamel shell was built up using IPS Empress Direct Enamel A2 and a palatal silicone key created from the mock-up. Dentin A3 was used for the dentine core and the mamelons. A natural-looking result was achieved owing to the translu- cent incisal effect created be- tween the mamelons using IPS Empress Direct Trans Opal. After that, the build-up was covered with a layer of IPS Empress Di- rect Enamel A2. The morphologi- cal structures were contoured and accentuated using fine dia- mond grinders, Arkansas stones, green grinders and polishing discs. Silicone polishers and dia- mond paste were used for polish- ing. The outcome was a harmoni- ous appearance of the maxillary anterior in terms of shape, shade and size (Figs. 11a & b). Discussion Although the presence of the papilla may not be the key issue after single treat- ment,8–10 preserving the papilla between two implants remains a implant AD ONLINE REGISTRATION NOW OPEN! Exhibition Panel Discussion Seminar Hands-On T: +62 812 9495 037 E: monic@pdgi.or.id Persatuan Dokter Gigi Indonesia PDGI - Persatuan Dokter Gigi Indonesia Drg. Monica Dewi R REGISTRATION INQUIRY PT. Traya Eksibisi Internasional Putri Damayanti T: +62 877 7767 3180 E: putri@trayaindonesia.com challenge. The decision in this case was to extract the two teeth in stages and use temporary res- torations to preserve the papilla. In addition, connective tissue grafts carried out at various points ensured ideal soft-tissue contours. Although only a few references regarding the stabil- ity of connective tissue grafts can be found in the literature, re- cent studies have shown promis- ing results.11 Since the aim is to establish a harmonious balance between the teeth and ensure appropriate white aesthetics, pre-operative planning and a detailed case analysis are advisable.12 It is also important to consider carefully which materials to use. In con- trast to zirconium dioxide and titanium, monolithic lithium disilicate restorations do not stimulate subgingival attach- ment to the soft tissue.13 There- fore, a hybrid abutment includ- ing zirconium dioxide or tita- nium could present an alterna- tive. Conclusion A multidisciplinary team ap- proach is essential to achieve a predictable treatment outcome. In addition, a detailed analysis and pre-operative planning pro- cedure play a crucial part. Here, photograph- and video-based evaluations present powerful in- struments. Acknowledgements: All pros- thetic procedures were conducted by Dr Sofie Velghe and all restora- tions were fabricated by dental technician Stephan van der Made. The authors wish to acknowledge the Kwalident dental laboratory and especially Mr van der Made for their contribution. Editorial note: A list of references is available from the publisher. Dr Aryan Eghbali is Deputy Head of the Depart- ment of Perio- dontology and Oral Implantol- ogy of the Vri- je Universiteit Brussel in Belgium. He can fe contacted at aryan.eghfali@vuf.ac.fe. Dr Sofie Velghe A specialist in prosthodontics, Dr Sofie Velghe is the founder of the Policlinic Tandheelkunde multidisciplinary dental clinic, which was estaflished in 2007. She can fe contacted at sofie.velghe@me.com.