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26 RESTORATIVE Dental Tribune Middle East & Africa Edition | 6/2017 For age-appropriate esthetics: Natural effects with VITA VM materials By Carolin Wehning, Germany It becomes especially challenging for dental technicians to produce natu- ral, age-appropriate reconstructions in the visible area of the mouth for older people. It is recommended to establish a very planned procedure based on the characteristics of the natural teeth for the individualiza- tion and characterization of such a restoration. This is the only way results can be achieved that fi t har- moniously into the remaining tooth substance. Dental technician Carolin Wehning (Bocholt, Germany) shows how such a complex case can be solved with VITA VM 9 veneer ce- ramics and VITA INTERNO materials for internal characterization (all VITA Zahnfabrik, Bad Säckingen, Germa- ny) in the following case study. shades of INT8 (blue), INT5 (brown), and INT7 (anthracite); the incision with INT2 (sand). Cracks and brown spots could be reproduced with INT10 (brown), and white spots with INT1 (white). Fig. 1: Initial situation: Composite structure at 21 af- ter distal transverse fracture of the tooth crown. Fig. 2: After matching the wax-up with the master model, the functional cap could be designed. Fig. 3: After determining the basic tooth shade 5M2 with the VITA Toothguide 3D-MASTER, the layer scheme is sketched. Fig. 4: The crown framework, prepared for veneering. Fig. 5: After a dentine fi ring, VITA INTERNO can be used for a second time to give depth with individual shade nuances. Fig. 6: The VITA INTERNO stains allow for a multifac- eted and age-appropriate reproduction of the natural teeth. Fig. 7: The fi nal fully ceramic crown has an age-ap- propriate morphology, surface texture and shading. Fig.8: The shading and lighting of the restoration fi ts perfectly in the overall picture Dental Institute Discover our range of high-quality, high-intensity postgraduate courses Study: MClinDent/MSc/Diploma • Full-time, part-time, on-campus and online • Online study includes residential blocks of training on-campus • Range of 19 courses including restorative specialty training Research: MPhil/MRes/PhD Four multidisciplinary science divisions • Craniofacial Development & Stem Cell Biology • Mucosal & Salivary Biology • Population & Patient Health • Tissue Engineering & Biophotonics RANKED NUMBER ONE IN EUROPE FOR DENTISTRY QS WORLD UNIVERSITY RANKINGS 2017 GLOBAL TOP 10 FOR CLINICAL, PRE-CLINICAL AND HEALTH (INCLUDING DENTISTRY) TIMES HIGHER EDUCATION WORLD UNIVERSITY RANKINGS 2015-16 RANKED NUMBER FOUR IN THE WORLD FOR DENTISTRY QS WORLD UNIVERSITY RANKINGS 2017 Find out more: visit www.kcl.ac.uk/dentistry email dental-postgraduate@kcl.ac.uk Fig. 9: Result: The patient is very satisfi ed with the fi nal esthetic result. 3. Finalization of the restorations After working out the basic mor- phology with the stone and the de- tails with a fi ne diamond, the inside crack was pulled from the outside with a fi ssure bur to achieve a three- dimensional effect. The surface tex- ture was kept as smooth as possible, in accordance with the patient's age. After the glaze fi ring, only a goat- hair brush and diamond polishing paste were used to slightly reduce the gloss effect. After trying out the fully-ceramic crown, the patient was very satisfi ed with the result, and a self-adhesive bond was applied. The shade and form of the restoration integrated harmoniously with the other teeth. The ceramic veneer in combination with two stain-colored fi res made it possible to achieve an age appropriate esthetic. Source: Dental Barometer. 6-2017, Barometer Verlagsgesellschaft mbH, Germany VITA® and other VITA products men- tioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany. Carolin Wehning Dental Technician, Bocholt, Germany 1. Assessment and planning A 77-year-old patient entered the dental practice after a coronal trans- verse fracture at 21, which had al- ready been treated with a direct composite structure. Clinically, the results were morphologically and esthetically inadequate. On the adja- cent natural tooth 11, age-related dis- colorations, initial white and brown spot lesions in the cervical area, and a vestibular transverse dark brown crack were apparent. The dentist and patient decided to restore the tooth with a full ceramic crown for long- term stabilization, in which the color effect of the adjacent tooth 11, was to be reproduced in detail. In order to achieve a predictable result, the situation was molded 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 precision mould. 2. CAD/CAM fabrication and veneering The crown framework was made of CAD/CAM supported VITA YZ HT zirconium dioxide. For a deep initial fl uorescent effect, a wash fi ring was performed with EFFECTLINER 5 (or- ange) and EL6 (green-yellow). “Lay- ering with VITA VM 9 was the basis for reproducing the basic shade. The VITA INTERNO materials then ena- bled me to intensify the deeper indi- vidual shade nuances after the wash and dentine fi rings,” said Wehning, describing the key steps of ceramic reproduction. INT04 (orange) and INT11 (gray-brown) were used in the cervical and interdental areas; INT5 (terracotta) was used in the center. The inside areas were nuanced with