Modern adhesive dentistry has provided clinicians with simpler reconstructive procedures by opening new scenarios that were once unthinkable, thanks to adhesive techniques. To this end we nowadays have the possibility to make partial restorations, both with feldspathic and glass ceramic on anterior teeth, with nearly no preparation, by performing minimal intervention on enamel that is, in any case, preserved with its integrity, enabling us to get the best possible adhesion.
The approach presented hereafter is a modern approach to partial anterior restorative procedures and a useful workflow to follow in all of the cases that won’t allow occlusal checks, if not after cementation.
The patient has undergone treatment at our office since 2009, year in with restorations on teeth 15, 16, 17, 24, 25, 26, 27, 36, 37, 45, 46, 47 had been made because of the presence of primary carious proximal and occlusal lesions, and root canal treatment was carried out on tooth 26 because of penetrating caries. She reports trauma on anterior teeth during her childhood: in fact, fracture signs are present on the enamel of tooth 12, without symptoms.
Early wear signs are also visible on the enamel of teeth 21, 31, 32, 41, 42 as a consequence to malocclusion with a deep bite.
In March 2011, under my advice, once the restorative treatments were finished, the patient accepts to undergo an orthodontic treatment to correct II class, II division malocclusion with a deep bite and right-sided open bite. She was therefore referred to my Orthodontist who carried out the malocclusion correction and teeth alignment.
In December 2013, after two-years buccal, fixed orthodontic treatment, the patient is sent back to my attention from the Orthodontist, who has ideally finalized the treatment: under the skeletal situation and the available space, some diastemas were still around 12 and 22, both mesially and distally. Orthodontic treatment had produce and increase in the over-jet and a reduction of the overbite while solving the deep bite former status. Overbite was caused also by wear of incisal margins of 21, 31, 32, 41, 42, and, as a result, was particularly insufficient by the end of the orthodontic treatment, and a poor anterior protrusion guide resulted as well.
I thus was asked by the orthodontist for an intervention to increase the overbite and to restore the anterior guide in protrusion, to achieve an improvement in posterior disclusion and closing of the residual, post-orthodontic diastemas.
The patient also asked for the best esthetic solution both in the short and in the long term.
At the end of treatment and at following photographic one-year check-up restorations show a good integration both with soft and hard tissues.
On the esthetic side the patient has benefited from restoring of shapes and shades which was performed, as the patient herself asked, with the best materials and techniques for a satisfying result both in the short and in the long term. Her expectancies were therefore fulfilled.
On the functional side the orthodontist´s request of anterior protrusion guidance improvement was granted. Overbite was increased by lengthening of incisal margins of teeth 31, 32, 41, 42 which, after orthodontic treatment had no contact with the upper antagonists nor in maximum intercuspation neither during protrusion.
The use of feldspathic ceramic veneers stratified and fired on a refractory material enabled us to work, in this specific case, with a completely additive procedure, thanks to the possibility, offered by this material, to be used with much smaller thicknesses than lithium disilicate, in a totally conservative manner and in full respect of hard and soft tissues, together with maximum exploitation of micro-mechanical adhesive potential of the enamel, on which adhesion of the restorations lays 100%.
Six months regular check-ups of this work, together with the periodontal support treatment, in addition to post-orthodontic stabilization with removable retainers after having changed the teeth shapes will guarantee the long-term success that the patient expected and the clinician aimed to.
Special thanks to Dr. Renato Cocconi for performing the pre-restorative orthodontic treatment and Mr. Simone Maffei for the laboratory work.
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