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.
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.
Initial close-up view of the anterior teeth.
A complete intraoral view of the initial situation.
Opening the contact points between the teeth and inter-proximal walls reduction about 0.5 -1 mm.
Conservative anatomical occlusal reduction with 15 degree inclination to achieve maximum retention while preserving tooth structure.
Using chamfer finishing bur to remove all sharp edges and undercuts to achieve a smooth finish line before the final impression.
Final preparation of the teeth.
The digital intra-oral scanner was used for recording. The complete scan was then sent to the laboratory.
The try-in stage is very important to check the fit of our prosthesis, and adaptation before the surface treatment of the lithium disilicate.
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).
After cementation, marginal fit and healthy gum are key to successful restorations in the long term.
Lateral view of the final situation. We can see maximum integration between margin of our prosthesis and gingiva.
Note how the inter-dental papillae naturally fill all the spaces between the teeth.
The aesthetic and functional requirements of the patient were successfully fulfilled.
Final smile of the patient.
The dentist and the patient were very happy with the final outcome.
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.
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