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Dental Tribune Middle East & Africa No. 4, 2017

26 ◊Page 25 Clinical procedure With the use of a GC Fit Checker Ad- vanced Blue (GC Europe), the precise fit observed on the model was con- firmed intraorally (Fig. 12). As the patient was also satisfied with the aesthetic result, the adhesive bridge could be placed immediately. For this purpose, the working field was isolated with rubber dam and a 37% phosphoric acid etching gel ap- plied to the palatal enamel surfaces of both lateral incisors for 30 seconds and to the dentine surfaces for 15 sec- onds before being rinsed off. The inner surfaces of the wings were conditioned to increase the surface roughness. After thorough clean- ing of the surfaces, an adhesive (3M Scotchbond Universal Adhesive) was applied, rubbed in, air-dried and RESTORATIVE Dental Tribune Middle East & Africa Edition | 4/2017 light-cured according to the manu- facturer’s instructions. Then, 3M RelyX Ultimate Adhesive Resin Cement was applied and the bridge placed. The excess cement was removed immediately with a sponge pellet. To prevent a reaction of the uncured cement with oxygen and lay the foundation for a good marginal in- Fig. 10: Final restoration on the model: A natural colour gradient is obtained. Fig. 11: Light transmission through the translucent framework material. Fig. 12: Use of fit checker to verify the precise fit of the restoration. Fig. 13: Interfaces between tooth and res- toration covered with glycerine gel. Fig. 14: Margins immediately after curing of the cement. Fig. 15: Aesthetically satisfying situation after eight weeks. Further recovery of the gingival tissues needs more time. Fig. 16: A natural look is obtained. tegrity, the exposed margins were covered with glycerine gel (Fig. 13) and polymerised. Figure 14 shows the situation immediately after cur- ing. Result The aesthetic appearance was al- ready satisfactory, although the harmony was impaired by black triangles between the teeth. Due to the favourable characteristics of the ceramic, however, the soft tissue re- covered quickly and closed the gaps. Figures 15 and 16 show the results 8 weeks after the restorative proce- dure. Discussion As an alternative to the selected treatment option, it would have been possible to place a removable partial denture or two two-unit ad- hesive bridges with one wing each. The former, however, is regarded as functionally less effective and not capable of supporting the preserva- tion of soft and hard tissues. The two- unit adhesive bridges would have re- quired stabilisation with a retainer. The main reason to opt against this alternative was the compromised value of the abutment tooth 22. As the root surfaces of the maxillary lat- eral incisors are small, it also seems questionable if this design would have offered sufficient stability to ensure the desired result. With regard to the restoration that was produced, the invasive prepa- ration is surely a matter of debate. However, the existing preparation for the metal-ceramic bridge and the large composite restorations limited the amount of sound tooth struc- ture that needed to be sacrificed at this point of the treatment to a minimum, so that the plan became acceptable. In general, the maxi- mum preservation of tooth struc- ture should always be given highest priority when a dental restoration is planned. Important criteria guiding the amount of hard tissue removal are the available intermaxillary space and the minimum wall thick- ness of the selected material. Due to the material selection in the present case, it is not necessary to remove the restoration as long as it serves its purpose. Thus, the planned long-term temporary might even become a definitive restoration over time. This, of course, is only possible with continuous monitoring and good compliance of the patient. Dr Jan-Frederik Güth, PD Jan_Frederik.Gueth@med. uni-muenchen.de Hans-Jürgen Stecher, MDT info@stecher-zahntechnik.de Celtra ® Press Developed to make a difference The benefits of the Celtra® Press system for your dental laboratory: • A unique combination of excellent esthetics and high strength > 500 MPa (natural opalescence and translucency, stable margins) • Excellent shade fidelity according to the VITA shade system and a surprising chameleon effect (easy shade adaptation to the surrounding teeth) • Simple and fast processing (minimal reaction layer, easy to polish, a simplified shade system reduces inventory costs) celtra-dentsplysirona.com Just try it! Celtra(cid:18) Zirconia-reinforced lithium silicate, ZLS The new generation of high strength glass ceramic. Celtra(cid:18) Press is now available for the traditional pressable- ceramics technology. The system includes ingots, investment, and veneering ceramics.

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