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ePaper created 2018-04-25, 08:59:39 | version 1.38.0
Dental Tribune Middle East & Africa Edition | 2/2018 LAB TRIBUNE B3 Achieving more with less Wafer-thin and brilliantly shaded: lab fabricated non-prep veneers for correcting misaligned teeth Fig. 1: Incisal view of the preoperative situation Fig. 2: Mock-up in wax placed on the model By Carola Wohlgenannt, MDT, Austria Lab-fabricated non-prep veneers made it possible to sidestep ortho- dontic treatment in the clinical case presented in this report. Despite the limited space available, brilliant shade dynamics were achieved with the help of specially shaded Enamel and Effect materials (IPS e.max Cer- am Selection). “Less is more”. However, using less is often difficult. In view of the high demand for minimally invasive res- torations, dental technicians are pre- sented with new challenges in many cases. The extent of the preparation is often reduced to minimize the in- vasiveness of the treatment, leaving only limited space for the fabrica- tion of an esthetically pleasing, func- tional restoration. Such situations necessitate adequate ceramic ma- terials and experience to reproduce the subtle interplay of shades seen in natural teeth. While previously various ceramic powders had to be combined with each other to create the required mixture, this procedure has now been simplified with the in- troduction of new ceramic materials. IPS e.max® Ceram Selection are spe- cially shaded Enamel and Effect ma- terials with brilliant shades and nat- ural-looking light-optical properties. The range comprises twelve shades that are divided into three groups. The six Special Enamel shades are designed to produce lively translu- cent effects in the enamel area. The three Light Reflector Effect materials have light-reflecting capabilities and are suitable for areas where a high brightness value is desired. The three Light Absorber materials with light-absorbing properties are used to increase the in-depth effect. With this variation in materials, imi- tating natural teeth with individual characteristics is much easier than before. The range of possibilities is particularly convenient in cases where space is limited, such as in very thin restorations (e.g. veneers). Clinical case The approximately 40-year-old patient wanted the position of her teeth corrected (Fig. 1). She consult- ed her dentist with regard to this problem. She rejected orthodontic treatment because of the expected costs, the long treatment time and the limitations during therapy. An orthodontist had recommended the extraction of a tooth in the lower jaw to compensate for the crowdedness and to provide the basis for ortho- dontic treatment. All of this was out of question for the patient. She also emphasized that no tooth structure should be removed for the esthetic correction. Fig. 3: Selecting the basic tooth shade (Dragon Shade, Drachenberg & Bellmann) Fig. 4 & 5: Selecting the IPS e.max Ceram Selection materials using shade tabs. On the right: shade tab with the intensive enamel shade “quartz”; on the left: shade tab with the light intensive Effect material “cream” Fig. 6: Master model with dies made of investment material Fig. 7: Investment material dies are being soaked with water Fig. 8: Building up the veneer for tooth 11 using IPS e.max Ceram Selection materials Fig. 9: Incisal view of the completed veneers on the model Treatment plan and mock-up The possibilities of an esthetic im- provement in the upper jaw were discussed together. In particular, teeth 11 and 13 were responsible for the unevenness in the dental arch. The teeth were inclined from the axis towards the palatal. The idea was to use two ceramic non-prep veneers to correct the misalignment and achieve harmony in the dental arch. With the help of a study model, the ideal tooth position was established in wax (Fig. 2) and then converted into “fast and easy” resin veneers (mock-up). The first impression after the placement of the mock-up was positive. There was a strong aha! ef- fect. The patient agreed to the treat- ment. The existing chalky spot on tooth 21 was masked with composite in the dental practice. Challenge: reproducing the shade of the natural tooth The shape and morphology of the veneers were defined by the mock- up. Fig. 10a: Veneer 11 features an insertion handle at the incisal edge to be removed by grinding once the restoration is seated Now a matching tooth shade for the ceramic materials had to be deter- mined. The challenges were posed by the dynamic interplay of shades, the “beautiful” translucency of the natural anterior teeth and the limit- ed space available. How can the light- optical properties be reproduced as perfectly as possible in only a wafer- ÿPage B4 Fig. 10b: Despite their thin layer thickness, the veneers exhibit natural light-optical prop- erties.