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ePaper created 2018-05-16, 11:45:19 | version 1.38.0
DIGITAL VS. ANALOG WORKFLOW ON TEN CERAMIC VENEERS IN THE MAXILLA: A case report Dr. Michalis Diomataris, Dr. Stavros Pelekanos & Michalis Papastamos, Greece — Dr. Michalis Diomataris — Dr. Stavros Pelekanos — Michalis Papastamos Background and aim Different materials and treatment options are available in esthetic and restorative dentistry for the anterior region. The con- ventional protocol, including an analog impression with polyether or polyvinylsi- loxane, a master cast and die fabrication, waxing and pressing of ceramic materials, requires exceptional skills and is tech- nique-sensitive. Intraoral scanning and digital impression taking provide an accu- rate alternative method for transferring information from the mouth to the dental laboratory.1 The digital file is always on the computer and can be immediately pro- cessed or at any time, unlike with the conven tional procedure. Regarding materials, various newer products, such as pressed or milled ceramics, offer enhanced strength and functionality; however, in thinner dimen- sions, they lack the inherent esthetic beauty of conventional materials such as feldspathic porcelain. As patient demand for better esthetics has increased in recent years so too has the need for restorative materials that closely mimic the patient’s natural dentition. Initially used for the creation of porcelain dentures, feldspathic porcelain has emerged as the premier esthetic material for custom veneer resto- rations. In recent years, the use of hand-layered powder/liquid feldspathic porcelain has been revived based on its highly esthetic values and little to no preparation requirements. By keeping preparation to a minimum, less tooth structure is removed and procedures are much less invasive, which is exactly what patients desire.2 In contrast, the conventional methods of ceramic fabrication have been described as time-consuming, technique-sensitive and unpredictable owing to the many vari- ables, and thus CAD/CAM may be a good alternative for both dentists and laboratories.3 CAD/CAM may also reduce the fabrication time of high-strength ceram ics by up to 90%.1 Furthermore, in- dustrially fabricated blocks are more homo genous, with minimal flaws, and CAD/CAM restorations have been found to compare favorably with other restor- ative options.4, 5 As far as optical properties and CAD/ CAM are concerned, the fact of complex optical illusion phenomena in anterior esthe tics cannot always be met with mono- chromatic esthetic materials without the need for final characterization by a dental technician. In order to overcome such esthe tic disadvantages of a monochro- matic restoration, multichromatic ceramic blocks have been developed to create a 3-D layered structure. These ceramic blocks offer a gradient of chroma from the cervical to the incisal areas that replicate dentin and enamel in the same block.6–8 The aim of this case report is to compare the analog versus the digital workflow on ten ceramic veneers in the maxilla, in terms of esthetic outcome, length of procedures and technical sensitivity for both the den- tist and the dental technician. Methods and materials A 35-year-old patient presented at the office with the chief desire that the esthet ics in the anterior region be changed (Fig. 1). A diagnostic wax-up was performed, followed by mock-up fabrica- tion, in order to obtain a preliminary visu- alization of the final outcome. Ortho- dontic treatment was proposed in order to align the teeth in a more favorable position for veneers requiring minimal preparation and to reduce the overbite. One year after treatment, the patient returned for the final prosthetic rehabil- itation (Figs. 2a & b). Digital smile design according to Coachman and Calamita9 18 — issue 2018 Esthetic and Restorative Dentistry Article