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08 TRENDS & APPLICATIONS Dental Tribune Asia Pacific Edition | 11/2017 vge-appropriate aesthetics Creating natural effects with VITA VM materials 1 4 7 2 5 8 3 6 9 Fig. 1: vnitial situation: Composite restoration of tooth #21 after distal transverse fracture of the tooth crown.—Fig. 2: After matching the wax-up with the master model, the functional crown was designed.—Fig. 3: The crown framework, prepared for veneering.—Fig. 4: After determining the basic tooth shade of 5M2 with the VvTA Toothguide 3D-MASTER (VvTA Zahnfabrik), the layering scheme w as sketched.—Fig. 5: After a dentine firing, VvTA vNTERNO can be used for a second time to give depth with individual shade nuances.—Fig. 6: The VvTA vNTERNO stains allow for a multifaceted and age-appropriate reproduction of the natural teeth.—Fig. 7: The patient was very satisfied with the final aesthetic result.—Fig. 8: The shading and lighting of the restoration fitted in perfectly with the overall picture.—Fig. 9: The final full-ceramic crown had an age-appropriate morphology, surface texture and shading. By Carolin Wehning, Germany For dental technicians, it is especially challenging to produce natural-look- ing, age-appropriate reconstructions in the visible area of the mouth in older people. It is recommended to follow a systematic procedure based on the characteristics of the natural teeth for the individualisation and characterisation of such a restora- tion. This is the only way results can be achieved that blend harmoniously with the remaining dentition. In this case study, I show how such a com- plex case can be solved with VITA VM 9 veneering ceramics and VITA INTERNO materials (both VITA Zahn- fabrik) for internal characterisation. Assessment and planning A 77-year-old patient pre- sented to the dental practice after a coronal transverse frac- ture of tooth #21 that had al- ready been treated with a direct composite. Clinically, the results were morphologically and aes- thetically inadequate (Fig. 1). On the adjacent natural tooth (#11), age-related discolorations, ini- tial white and brown spot lesions in the cervical area, and a vestib- ular transverse dark-brown crack were apparent. The dentist and patient decided on restoration of the tooth with a full-ceramic crown for long-term stabilisa- tion, on which the colour effect of tooth #11 was to be repro- duced in detail. In order to achieve a predictable result, the situation was moulded and a model was developed for a wax-up. Tooth #21 was prepared for a full crown and a master model was produced using a pre- cision mould (Fig. 2). CAD/CAM fabrication and veneering The crown framework was made of CAD/CAM-supported VITA YZ HT zirconium dioxide (Fig. 3). For a deep initial fluores- cent effect, a wash firing was per- formed with EFFECT LINER 5 (orange) and EFFECT LINER 6 (green-yellow). Layering with VITA VM 9 was the foundation for reproducing the basic shade (Fig. 4). The VITA INTERNO materi- als then enabled intensification of the deeper individual shade nu- ances after the wash and dentine firings (Figs. 5 & 6). Int 04 (orange) and Int 11 (grey-brown) were used in the cervical and interdental areas; Int 05 (terracotta) was used in the centre. The inside areas were nuanced with Int 08 (blue), Int 05 (terracotta) and Int 07 (an- thracite), and the incisal edges with Int 02 (sand). Cracks and brown spots were reproduced with Int 10 (brown), and white spots with Int 01 (white). Finalisation of the restorations After establishing the basic morphology with a stone and the details with a fine diamond-coated bur, the interior crack was recre- ated from the outside with a fis- sure bur to achieve a 3-D effect. The surface texture was kept as smooth as possible, in accordance with the patient’s age. After the glaze firing, only a goat hair brush and diamond polishing paste were used to slightly reduce the gloss effect. After trying out the full-ceramic crown, the patient was very satisfied with the result (Fig. 7), and a self-adhesive bond- ing agent was applied. The shade and form of the restoration inte- grated harmoniously with the other teeth (Fig. 8). The veneering ceramic, in combination with two stain firings, made it possible to achieve age-appropriate aesthetics (Fig. 9). Editoriml note: This mrticle wms first published in Dentml Bmrometer, Issue 6/2017. Carolin Wehning is a dental technician in Bocholt in Germany.