Fig.1

A 28-year-old female patient (a dentist) presented to the clinic with a chief complaint of restoring her two upper central incisors. She had lost tooth #11 four months earlier due to an accident. At that time, the surgeon extracted the fractured root and placed an implant with good primary stability, giving the green light for immediate temporization.
A freehand composite provisional crown was fabricated directly over the temporary abutment, fixed, and torqued according to the manufacturer’s recommendation. The temporary crown was designed to be out of occlusion and functional movements.

Fig.2
Clinical examination revealed a tilted midline axis and an old Class IV composite restoration on tooth #21. To correct the midline discrepancy and achieve symmetrical spacing between the two central incisors, replacement of the existing restoration was planned.
The available restorative options included:

1. 1. Direct composite restoration
   2. Indirect ceramic veneer
   3. Indirect partial ceramic veneer

The patient requested a treatment that would ensure both longevity and minimal invasiveness. Therefore, we agreed on option three: the indirect partial ceramic veneer.

Fig.3
Shade selection was performed using cross-polarized photography to ensure accuracy. The value and enamel shade were determined from the incisal third, while the hue, chroma, and dentin shade were selected from the middle and cervical thirds.

Fig.4
The procedure began with the removal of the implant temporary crown.

Fig.5
Implant gingival emergence profile.

Fig.6
The old composite restoration was carefully removed using a fine bur under high magnification, assisted by fluorescence light for precise differentiation between composite and tooth structure. The surface was then smoothed with an ultra-fine polishing disk.
Step 1: Fabrication of the partial veneer and selection of the appropriate abutment.Intraoral scanning was performed for both the partial veneer preparation and the implant scan body.

Fig.7
A lithium disilicate partial veneer was fabricated using a fully pressed MT ingot, shade B1. The restoration was polished but not glazed, as the margins required intraoral finishing and polishing after cementation.
My gratitude to the ceramist artist Mr. Noman Hamzeh, (Ideas Dental Lab, London / Muscat).

Fig.8
Isolation.

Fig.9
The partial veneer was bonded following a strict adhesive protocol to ensure optimal adhesion and marginal integrity. Finishing and polishing were then performed using a fine and ultra-fine ceramic polishing sequence, which included a white stone polisher, a two-step rubber cone system, and ceramic polishing paste for the final gloss.

Fig.10
Ceramic polishing paste in action.

Fig.11
Multiple rounds of fine and ultra-fine ceramic polishing were performed to refine the margin.

Fig.12
Step two: restoring the permanent implant crown.

Fig.13
The temporary crown was utilized to replicate the implant’s gingival emergence profile.

Fig.14
Coping the implant gingival emergence profile using putty, open-try impression coping & resin pattern.

Fig.15
Ready.

Fig.16
Confirming the fit with IOPA, a dynamic abutment system to be used to achieve a screw-retained implant crown, optimizing both esthetics and retrievability.

Fig.17
The impression.

Fig.18
A dynamic abutment system was used to achieve a screw-retained implant crown, optimizing both esthetics and retrievability.
Shot on the delivery day.

Fig.19
Shade matching under cross-polarization filter.

Fig.20
One week follow-up.

Fig.21
Final situation.

Conclusions

This case demonstrates a minimally invasive and highly esthetic approach to anterior teeth restorations through the integration of digital workflow, conventional techniques, and adhesive dentistry. By utilizing a lithium disilicate partial veneer, preserving as much enamel as possible, the restoration was fully bonded to enamel, ensuring strength and longevity. Alongside a screw-retained implant crown supported by a dynamic abutment system, both functional esthetic and retrievability were achieved. Careful planning, precise bonding, and meticulous polishing protocols resulted in a seamless integration with the surrounding dentition and soft tissues. The patient expressed high satisfaction with the final outcome in terms of color, form, and overall smile appearance.

Bibliography

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