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ePaper created 2018-05-16, 11:45:19 | version 1.38.0
Fig. 17a Fig. 17b Fig. 17c Fig. 17d Fig. 17e Fig. 18b Fig. 18a Fig. 17a Final outcome one week later. Fig. 17b Final outcome one week later, frontal view. Fig. 17c Lips at rest, exposure of the incisal edges. Fig. 17d Wide smile. Fig. 17e Extraoral final photographs. Fig. 18a Subjective comparison criteria per step between analog and digital work- flows. Fig. 18b Laboratory duration per step between analog and digital workflows. PVS = polyvinylsiloxane. was performed, from which a treatment plan of crown lengthening and veneers on teeth #15–25 (Fig. 3) was proposed. A conventional diagnostic wax-up was also produced (Fig. 4). Both digital and con- ventional mock-ups were applied, and agreement was attained concerning tooth shapes and proportions. Crown lengthen- ing was performed, guided by the digital mock-up, with the use of an acrylic trans- parent double crown lengthening guide that indicated the borders of the gingi- vectomy and alveolectomy needed in periodontal surgery for esthetic rehabil- itation (Figs. 5, 6a & b).10 After six months of tissue stabilization (Fig. 7), a mock-up was produced with Telio CS C&B (Ivoclar Vivadent) chairside (Figs. 8a & b), and tooth preparations with silicone guides were performed (Figs. 9a–c). Both conventional impres- sions with polyvinylsiloxane (Fig. 10) and digital impressions (TRIOS, 3Shape) were taken (Fig. 11). Provisionalization was executed digitally, using Telio CAD (Ivoclar Viva- dent) in the Wieland Select CNC milling machine. The design was performed with the 3Shape Dental Designer 2015 software (Figs. 12a & b). Two sets of final resto- rations were fabricated. The set of feldspathic veneers was fabricated on a stone model using IPS Style (Ivoclar Viva- dent), while IPS Empress CAD Multi (Ivoclar Vivadent) was used for the digital set (Figs. 13 & 14). Both sets were examined intraorally with a try-in paste to compare the optical properties of the feldspathic and the CAD/CAM veneers (Figs. 15a–c). The subjective decision of the clinician and the patient was to cement the feld spathic veneers, owing to slight differences in the length of the central incisors between the two sets. Adhesive procedures followed (Figs. 16a–f), and final intraoral and extraoral photographs were captured one week later (Figs. 17a–e). Results Intraoral digital scanning is a perfect alter- native clinical procedure compared with the conventional impression technique. The digital planning and mock-up procedure is a powerful communication tool for the dentist, although special skills in using com- puter software are required. Regarding the laboratory workflow, most of the analog procedures require more time (refractory dies, built-up veneers, adjustments), except the staining/glazing (Figs. 18a & b). Although the esthetic outcome of the feld- spathic veneers was subjectively chosen in this case, the analog workflow is much more demanding. The digital approach, because of the reduced difficulty, speed, complexity and patient discomfort, tends to be preferable (Figs. 18a & b). Conclusion Knowledge and application of virtual smile design procedures, coupled with innova- tive dental laboratory technologies, allow dentists to diagnose, plan, create and deliver esthetically pleasing new dental compositions. Furthermore, advances in CAD/CAM technology have catalyzed the development of esthetic veneer resto- rations with industrially produced materi- als possessing superior biomechanical properties and good esthetics. Editorial note: A list of references is available from the publisher. Article Esthetic and Restorative Dentistry issue 2018 — 21