Dental Tribune Asia Pacific Edition No.7+8, 2017

14 TRENDS & APPLICATIONS Dental Tribune Asia Paciﬁ c Edition | 7+8/2017 3 5 7 9a 10 4 6 8 9b 11 Fig. 3: IPS e.max ZirPress G4 was used for imitation of the gingiva. The basic opacity of the crowns was deﬁ ned with IPS e.max Ceram Deep Dentin A3. Then, (1) IPS e.max Ceram Dentin A3.5, (2) IPS e.max Ceram Power Dentin A3.5 and (3) IPS e.max Ceram Selection Light Absorber fog and Light Absorber taupe were applied in a layered build-up. We were able to create a wonderful contrast in the ivory-coloured layer. — Fig. 4: Next, (4) IPS e.max Ceram Special Incisal grey and Cervical Transpa orange, (5) IPS e.max Ceram Selection Special Enamel quartz and IPS e.max Ceram Opal Effect 2 (OE 2) were applied to imitate depth within the neck of the tooth. For the char- acterisation of the incisal edge, we used (6) IPS e.max Ceram Mamelon light, (7) IPS e.max Ceram Selection Light Reﬂ ector salmon, (8) IPS e.max Ceram OE 1, (9) IPS e.max Ceram Selection Light Absorber taupe, (10) IPS e.max Ceram Power Incisal and (11) IPS e.max Ceram Deep Dentin BL 3 and OE 2. —Fig. 5: In addition, the mamelons were applied directly at the labial and lingual aspects. For this, we used (12) IPS e.max Ceram Deep Dentin A3 and Occlusal Dentin orange in order to achieve an illusion of depth to the incisal edge. The translucency of an incisal edge is determined by the proportion of layered ceramic on the labial aspect and by a cut-back on the lingual aspect. — Figs. 6 & 7: It was possible to restore the teeth and soft tissue aesthetically and functionally. The ceramic enabled excellent shade reproduction with many individual characteristics. — Fig. 8: Initial situation: in addition to the mismatch of shade and morphology, functional problems were identiﬁ ed. — Figs. 9a & b: Before and after the intervention in region #22. The soft-tissue situation was managed by surgical treatment and temporary restorations. — Figs. 10 & 11: Framework made from an IPS e.max Press LT A1 ingot. The contrast within the crown was enhanced by applying the stains inside the crown. depending on the opacity of the framework material, the appropri- ate brightness can be achieved by means of Deep Dentin or Power Dentin (IPS e.max Ceram), even in materials with a high translu- cency. In order to reproduce the natural tooth shade, it is impor- tant to understand light transmis- sion and reﬂ ection. Likewise, the skilled application of light optical effects (e.g. ﬂ uorescence and opal- escence) is of signiﬁ cance. This is where the new IPS e.max Ceram Selection Enamel and Effect mate- rials are of use. With this out- standing set of materials, lifelike tooth characteristics can be re- produced even more accurately. Figures 3–5 illustrate the layered build-up. In order to achieve full aes- thetic integration of the implants, in addition to the shade and shape of the teeth, it is important to en- sure that the surface texture is ad- justed to suit the oral environ- ment. To allow the surface texture to appear as natural as possible, ﬁ ne characteristics (e.g. surface gloss) must be imparted. The sur- face gloss changes the light reﬂ ec- tion; it therefore affects the shade. For this reason, it is imperative to adjust the surface texture care- fully. In this case, the IPS Ivocolor staining and glazing system was used for surface ﬁ nishing. Results The ﬁ nished crowns were screw-ﬁ xed to the implants and the result was assessed. The natu- ral appearance was enhanced by a conscious asymmetry of the teeth, among other factors. The gingival contours were ideally adjusted. The teeth (crowns) and soft tissue com- plemented each other beautifully. The individuality was shown here perfectly. Although this was a chal- lenging and complex case, the re- sults were pleasing for all involved and it exceeded the pretreatment prognosis (Figs. 6 & 7). Case 2 Initial situation and treatment plan This patient was also around 50 years old at the time of treat- ment and came to the practice with an aesthetic problem in the ante- rior region. The existing restora- tions on teeth #23–12 were defec- tive and strongly discoloured and no longer suited the patient’s re- quirements. A slight overbite was noted. Tooth #23 had inadequate contact with the antagonist. In ad- dition, vertical and horizontal re- sorption of the alveolar ridge in re- gion #22 was observed. Resorption of the soft tissue owing to tooth loss also affected the situation (Fig. 8). This patient needed extensive treatment in order to achieve an aesthetically pleasing result. An alveolar ridge augmentation pro- cedure was thus ﬁ rst performed. On the basis of the pre-operative examination, a soft-tissue recon- struction was then carried out. The aim was to create a harmoni- ous gingival area (Figs. 9a & b). In this case, sufﬁ cient tissue was im- portant, since the horizontal re- sorption of the alveolar ridge ad- versely affected the vestibular ex- tent of the crowns. By the time the temporary restoration had been made, the ﬁ nal result had already been deﬁ ned and the framework for the ﬁ nal restoration planned. It should be pointed out that, in the case of aesthetic restorations, close cooperation between dentist and dental technician is essential. Of course, the patient too must be involved in planning and treat- ment. The treatment goals are de- termined together in order to achieve outstanding and satisfac- tory results for all involved. Fabrication of the restoration The frameworks (crowns and bridge) were produced from the lithium disilicate glass-ceramic IPS e.max Press (Ivoclar Vivadent; Fig. 10). Since the reproduction of translucency is a challenge in a lay- ered ceramic restoration, contrast effects were applied within the crown during a previous staining process (Fig. 11). In addition, an ap- pearance that underlines the ma- terial advantages can be achieved by means of a partial cut-back. IPS e.max Press offers countless possi- bilities for the production of aes- thetic restorations. In this case, the framework was speciﬁ cally re- duced and therefore a perfect basis was created. The vestibular regions were then built up with ceramic layers. After the internal shade composition and adjustment of the tooth morphology were com- plete, IPS Ivocolor was used to rep- licate the surface characteristics. In contrast to conventional stains, these stains can be ﬁ red at a lower ﬁ ring temperature of 710 °C. The reasons for staining are adjust- ment of the degree of saturation, characterisation and correction of the internal structure.

Dental Tribune Asia Pacific Edition No.7+8, 2017

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