Digital tools for a life-changing smile transformation

Using digital impression and teamwork with the technician allows to perform high-precision treatments with amazing aesthetic results. It also allows for the transformation of an entire smile in the shortest possible time, using materials that perfectly reproduce the mechanical and optical properties of natural teeth. In this clinical case, we will see the transformation of a smile that suffered from congenital agenesis of both upper laterals, without using any impression material.

styleitaliano style italiano smile with hypoplasia and missing laterals

Fig.1
This young-aged female patient, with missing both laterals and enamel hypoplasia of both labial and palatal surfaces in the upper anterior teeth, came asking to improve her smile. In addition to these congenital defects, she didn’t like the shape, size or color of her teeth, so it was crucial to involve her in treatment planning, to achieve the esthetic and functional goals in a reliable and efficient way.

styleitaliano style italiano smile with agenesis of lateral incisors

Fig.2
Initial situation.

styleitaliano style italiano intraoral close up showing smile with enamel hypoplasia and missing lateral incisors

Fig.3
Initial close-up view of the anterior teeth.

styleitaliano style italiano intraoral anterior photo set

Fig.4
A complete intraoral view of the initial situation.

styleitaliano style italiano bur preparing buccal surfaces

Fig.5
By using prep 0.5 flame bur (Style Indiretto Burs Kit – Intensiv, Switzerland) for the reduction of labial surface of the teeth.

style italiano styleitaliano intensiv burs styleINDIRETTO banner
style italiano styleitaliano intensiv burs styleINDIRETTO banner
styleitaliano style italiano steps of prosthetic preparation

Fig.6
Opening the contact points between the teeth and inter-proximal walls reduction about 0.5 -1 mm.

styleitaliano style italiano preparation of dental abutments

Fig.7
Conservative anatomical occlusal reduction with 15 degree inclination to achieve maximum retention while preserving tooth structure.

styleitaliano style italiano finishing line definition with gum retraction

Fig.8
Using chamfer finishing bur to remove all sharp edges and undercuts to achieve a smooth finish line before the final impression.

styleitaliano style italiano finished preparation of upper arch

Fig.9
Final preparation of the teeth.

styleitaliano style italiano eighteeth intraoral digital scanner

Fig.10
A new comprehensive intra-oral scanner (Eighteeth Helios 600) was used. It is accurate, lightweight, and fast, and includes two removable scanner tips in 2 optional sizes.

Helios 600 Eighteeth Styleitaliano Style italiano banner intraoral scanner
Helios 600 Eighteeth Styleitaliano Style italiano banner intraoral scanner
styleitaliano style italiano complete view of upper arch scan

Fig.11
The digital intra-oral scanner was used for recording. The complete scan was then sent to the laboratory.

styleitaliano style italiano try in of lithium disilicate crowns

Fig.12
The try-in stage is very important to check the fit of our prosthesis, and adaptation before the surface treatment of the lithium disilicate.

styleitaliano style italiano smile after cementation of crowns

Fig.13
A a multi-wave curing pen (Curing Pen, Eitghteeth) was used during cementation. This curing light is easy to use as it features a 360° rotatable head and multiple curing options (ramp mode, pulse mode and caries detection).

curing pen light style italiano styleitaliano eighteeth
curing pen light style italiano styleitaliano eighteeth
styleitaliano style italiano cemented lithium disilicate crowns

Fig.14
After cementation, marginal fit and healthy gum are key to successful restorations in the long term.

styleitaliano style italiano side view showing natural looking crowns

Fig.15
Lateral view of the final situation. We can see maximum integration between margin of our prosthesis and gingiva.

styleitaliano style italiano occlusal view of lithium disilicate crowns

Fig.16
Occlusal view.

styleitaliano style italiano papillae filling gingival embrasures after crown restoration

Fig.17
Note how the inter-dental papillae naturally fill all the spaces between the teeth.

styleitaliano style italiano before and after disilicate crowns

Fig.18
The aesthetic and functional requirements of the patient were successfully fulfilled.

styleitaliano style italiano smile after prosthodontic treatment

Fig.19
Final smile of the patient.

styleitaliano style italiano satisfied patient after prosthodontic treatment of upper arch

Fig.20
The dentist and the patient were very happy with the final outcome.

Conclusions

It is mandatory to keep in mind all the key components of smile design in treatment planning, and also to have invisible margins of the restorations, by positioning the finish lines appropriately. A well bonded restoration to enamel can last for decades and that should be the aim of clinicians trying to practice indirect bonded dentistry with lithium disilicate separated crowns.

Intra-oral scanners can bring many advantages into our daily practice, such as time saving, increasing accuracy, reducing manual errors specially in challenging cases.

Bibliography

1. Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations: Recommendations for success. J Am Dent Assoc. 2011;142(Suppl 2):20–4S.
2. Guess PC, Schultheis S, Bonfante EA, Coelho PG, Ferencz JL, Silva NR. Allceramic systems: Laboratory and clinical performance. Dent Clin North Am. 2011;55:333–52.
3. Hasanzade M, Aminikhah M, Afrashtehfar KI, Alikhasi M. Marginal and internal adaptation of single crowns and fixed dental prostheses by using digital and conventional workflows: A systematic review and meta-analysis, J Prosthet Dent. 2021 Sep;126(3):360-368. Epub 2020 Sep 12.
4. Tsirogiannis P, Reissmann DR, Heydecke G. Evaluation of the marginal fit of single-unit, complete-coverage ceramic restorations fabricated after digital and conventional impressions: A systematic review and meta-analysis. J Prosthet Dent 2016 Sep;116(3):328-335.e2.

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