Good practice in minimal preparation. How to get your patient and technician what they need.

When practicing esthetic dentistry, we all want to stay minimally invasive while getting simplified procedures while trying to achieve the best result for our patient. Yet, when it also comes to the lab, we need to resort to a few tricks up our sleeve to make our technician’s job easier.
This patient came to my attention complaining of the darkening of his upper left central incisor after undergoing and orthodontic treatment. He also complained about the two central incisors having a different shape and the large diastema in between.

styleitaliano style italiano incisors with old composite restorations

Fig.1
Both teeth had composite old fillings, so we decided to start by taking an impression and moving to the lab to lay out a plan. Our goal was to save the largest possible amount of enamel to ensure the best adhesive outcome in the long run.

styleitaliano style italiano stamping mock up

Fig.2
The project included two additive restorations to save the sound enamel on both teeth and mask the discolored substrate. We proposed two disilicate veneers as the final solution, showing the mock up to the patient to get his approval.

styleitaliano style italiano intensiv style indiretto bur kit for indirect restorative

Fig.3
The whole preparation procedure was performed using the Style Indiretto bur kit (Intensiv) following the veneer sequence you can find in the picture.

style italiano styleitaliano intensiv burs styleINDIRETTO banner
style italiano styleitaliano intensiv burs styleINDIRETTO banner
styleitaliano style italiano incisal preparation through mock-up

Fig.4
So we started from the preparation. After placing the mock up in the mouth, I started by shortening the incisal edge by 0.5 mm, with an appropriately dimensioned.

styleitaliano style italiano veneer preparation burs

Fig.5
With the second bur, i reduced the buccal surface by 0.5 mm, and then I united the horizontal grooves left with the 1mm bur, halfway through to ensure a controlled 0.5 mm reduction.

styleitaliano style italiano creating space for incisal characterization

Fig.6
It is very important to slice the incisal edge, to leave adequate spacing for the technician in this esthetically crucial area. Then, with the help of the LM Eccesso instrument, i removed the remaining parts of the mock up from the teeth.

style italiano styleitaliano lm arte anterior instrument
style italiano styleitaliano lm arte anterior instrument
styleitaliano style italiano marked buccal area to be reduced

Fig.7
Another crucial area is the central core of the tooth. This part needs to be over prepared just a little bit, in order to avoid getting a convex shape of the veneer due to limited spacing.

styleitaliano style italiano flattening of medial third of central incisor

Fig.8
So I proceeded to flatten this area very delicately.

styleitaliano style italiano finishing of veneer preparation

Fig.9
The last crucial steps included using a disc to round up the the corners of the preparation (upper left), a bur to better define the azimuth in the cervical area (upper right), a 30 micron bur (lower left) to smoothen the preparation, and a flam bur to cancel any possible undercuts (lower right).

styleitaliano style italiano finished veneer preparations

Fig.10
The finished preparations had an almost vertical cervical area. Most of the enamel was preserved. Only four burs and one disc for «peeling» the tooth accordingly with the technician’s project were used.

styleitaliano style italiano thickness guide check

Fig.11
The depth of the preparation was double-checked with the silicone buccal guides. An adequate thickness of the veneer will match perfectly with the project approved, giving the technician freedom to make any characterization needed and to add any wanted detail.

styleitaliano style italiano pick pack inserting retraction cord into sulcus

Fig.12
The Pascal Pick Pack was used to place the retraction cord to move the gum a bit apically to take a perfect impression.

pick pack banner pascale style italiano styleitaliano
pick pack banner pascale style italiano styleitaliano
styleitaliano style italiano protection of undercuts with soft wax

Fig.13
As a tip, I suggest to place a small amount of soft wax to close small gaps in between teeth to avoid tearing of the elastic impression material.

styleitaliano style italiano precision impression

Fig.14
The precision impression was taken using a polyether.

styleitaliano style italiano milled disilicate and lab model

Fig.15
Model and the milled disilicates (thanks to DT Daniele Rondoni).

styleitaliano style italiano raw and fired disilicates

Fig.16
Finalization of the veneers. The final shape will be determining for the esthetic success.

styleitaliano style italiano provisional flowable veneers

Fig.17
Temporary in place, after one week. The temporary restorations were made of flow composite, coping the mock up and pushing the material a bit apically the cervical margin.

styleitaliano style italiano lithium disilicate central incisor veneers

Fig.18
The two veneers ready to be treated and cemented in the mouth.

styleitaliano style italiano prepared incisors before veneer cementation

Fig.19
When I need to cement 2 central veneers, and I can isolate the laterals and feel able to control humidity, I do prefer not to use the rubber dam. It helps my concentration on the esthetic positioning of the veneers. No shame in that!

styleitaliano style italiano model before and after preparation

Fig.20
Some details. The initial impression (top), the prepared teeth (bottom) in the frontal view.

styleitaliano style italiano occlusal view of initial model and esthetic project

Fig.21
Occlusal view of the preparations (top) and the project (bottom). An adequate addition helps rejuvenate the teeth and save the thin buccal enamel for a perfect adhesion.

styleitaliano style italiano before cemented veneers

Fig.22
Before.

styleitaliano style italiano cemented veneers

Fig.23
Veneers after cementation. Note the good harmony pink/white harmony.

styleitaliano style italiano optishade colorimeter comparison

Fig.24
Color was checked with Optishade (Smileline). A colorimeter helps integration of mathematical data within the lab work to achieve perfect results.

banner optishade colorimeter app style italiano styleitaliano
banner optishade colorimeter app style italiano styleitaliano
styleitaliano style italiano detail of veneers after cementation

Fig.25
Final pictures with bouncers help see the value of the project and the shape of the surfaces.

styleitaliano style italiano lithium disilicate veneers on central incisors

Fig.26
Final result.

Conclusions

A great technician today is an architect. He’s the one making a good plan for the dentist. On his end, a good dentist is able to transform the plan in reality with very few touches. Only this synergy can make dentistry easy and accessible to everyone.

Bibliography

1.Manauta J, Salat A, Putignano A, et al. Natural, polarized light and the choice of composite: a key to success in shade matching of direct anterior restorations- Part I. Tropical Dental Journal. 2016 Sep;39(155):11-19.
2.Salat A, Devoto W, Manauta J. Achieving a precise color chart with common computer software for excellence in anterior composite restorations. Eur J Esthet Dent. 2011 Autumn;6(3):280-96. PMID: 21876865.
3.Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent. 2010 Spring;5(1):102-24.

style italiano styleitaliano Essential Dentistry kit online on demand course
style italiano styleitaliano Essential Dentistry kit online on demand course

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