Indirect Smile makeover with Style Indiretto

An indirect smile makeover requires thorough treatment planning, the right technique, and also the selection of the right tools, including the preparation bur kit to provide the most suitable bur sequence. A good bur selection, such as the Style Indiretto kit by Intensiv, for all indirect restorations such as veneers, crowns and onlay/overlay restoration means no need for using extra burs. This single kit provides simplicity and flexibility by offering all the burs that are commonly used in indirect restorations. This article shows the step by step to an indirect smile makeover using the Style Indiretto kit.

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style italiano styleitaliano intensiv burs styleINDIRETTO banner
styleitaliano style italiano old defective restorations

Fig.1
A young female patient came to the clinic complaining of the unpleasant aesthetics of her smile. She wanted to have a beautiful teeth and to smile with confidence.

styleitaliano style italiano esthetic defects in smile

Fig.2
Her smile presented a few esthetic issues ranging from midline deviation, uneven gingival display during smile, and defective old restorations.

styleitaliano style italiano intraoral view of old unpleasant restorations

Fig.3
This retracted view shows the patient was missing her upper right canine, and had a defective porcelainfused-to-metal (PFM) bridge on the left side. She also had old composite veneers on the remaining anterior teeth.

styleitaliano style italiano highlights of esthetic issues to be corrected

Fig.4
The black contrasted view shows the discrepancies between right and left side, lacking symmetry in tooth to tooth proportions, gingival level and teeth long axis.

styleitaliano style italiano digital smile design

Fig.5
Simulation the final result by DSD. After discussing the treatment with the patient we decided to proceed as follows:
1- Correction of the gingival asymmetry by crown lengthening, to achieve a symmetric pink contour.
2- Removal of old PFM bridge
3- E-max crown restorations

styleitaliano style italiano stitches after crown lengthening

Fig.6
First, crown lengthening surgery was performed and the gingiva was left to heal.

styleitaliano style italiano teeth after removal of old bridge

Fig.7
After healing, the PFM bridge was removed.

styleitaliano style italiano teeth after removing old restorations

Fig.8
The old defective composite veneers were also removed before starting preparation.

styleitaliano style italiano waxed up model

Fig.9
A wax-up was done with the aim of simulating the final result through fabrication of a mock-up, which would also serve as the project for the fabrication of silicone indices as a guide during preparation.

styleitaliano style italiano silicone key try in

Fig.10
The wax-up-based silicone key was also used to quickly fabricate provisional restorations. During this step, remember to wait for the gel phase before removing the excess material.

styleitaliano style italiano mock up for minimally invasive preparation

Fig.11
With the aim of minimizing loss of tooth structure, preparation through the mock-up was chosen.

styleitaliano style italiano style indiretto intensiv bur kit

Fig.12
For the whole preparation, the Style Indiretto kit (Intensiv) was used.

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style italiano styleitaliano intensiv burs styleINDIRETTO banner
styleitaliano style italiano style indiretto crown preparation sequence

Fig.13
Styleitaliano sequence for crown preparations:
STYC1 Palatal reduction
STYC2 Axial and incisal reduction
STYC3 Fine preparation

styleitaliano style italiano depth bur

Fig.14
Mock-up guided preparation starts with depth marker bur (optional).

styleitaliano style italiano depth guide grooves marked with pencil

Fig.15
Marking the depths with a pencil is very helpful in controlling the depth of the preparation to save sound tooth structure.

styleitaliano style italiano buccal reduction to calibrated depth

Fig.16
Labial reduction according the depth marks.

styleitaliano style italiano pick pack inserting retraction cord

Fig.17
After labial and proximal reduction and opening of the contact areas, we were ready to pack the retraction cords by using the PickPack instrument (Pascal).

pick pack banner pascale style italiano styleitaliano
pick pack banner pascale style italiano styleitaliano
styleitaliano style italiano subgingival abutment preparation

Fig.18
The preparations were completed by locating the cervical margin subgingivally.

styleitaliano style italiano palatal abutment refinement

Fig.19
Palatal reduction by using a large football diamond bur.

styleitaliano style italiano incisal and proximal preparation spacing check

Fig.20
After softening and smoothening the preparations by using the fine grain bur, we made sure we created enough incisal space for natural-looking final restorations.

styleitaliano style italiano checking buccal preparation spacing with silicone key

Fig.21
Also, buccal spacing was checked to follow the three labial planes.

styleitaliano style italiano prepared abutments with retraction cord

Fig.22
After finishing and polishing the final preparations.

styleitaliano style italiano double paste precision impression

Fig.23
The impression was taken with a double paste technique, using a soft putty and a light body to fill all the spaces created by the second retraction cord.

styleitaliano style italiano lithium disilicate crowns

Fig.24
Lithium disilicate (E-max) crowns were fabricated by the dental lab.

styleitaliano style italiano veneer me tool for lab work handling

Fig.25
Using Veneer Me is a must in my practice when handling lab work.

styleitaliano style italiano crowns on veneer me sticky pad

Fig.26
The first step of E-max bonding is etching by hydrofluoric acid for 20 seconds. Then the acid is rinsed out, and the surface of veneer is dried thoroughly.

styleitaliano style italiano crowns displayed onto the veneer me sticky pad

Fig.27
The next step is to apply a thin layer of silane and keep it 1-3 minutes. Then we apply the adhesive.

style italiano styleitaliano smileline veneer me
style italiano styleitaliano smileline veneer me
styleitaliano style italiano rubber dam isolation for adhesive cementation

Fig.28
Cementation under rubber dam is highly recommended for good bonding of the preparations and long-term bond stability.

styleitaliano style italiano crown cementation in progress with retracted rubber dam

Fig.29
Good retraction of the rubber dam can be achieved by B4 clamps.

styleitaliano style italiano lithium disilicate crowns after cementation

Fig.30
5 days after cementation, waiting for complete healing of the gingiva.

styleitaliano style italiano smile right after crown cementation

Fig.31
The final situation after correction of the gingival display, midline deviation and replacement of the old defective restorations.
The patient is very satisfied with result.

styleitaliano style italiano lithium disilicate crowns after healing

Fig.32
Two-month follow-up. You can see the complete healing of the gingiva, and the newly achieved symmetry.

styleitaliano style italiano smile with healthy gingiva after crown smile makeover

Fig.33
Full smile.

Conclusions

StyleItaliano protocols and tools, such as the Style Indiretto bur kit, provide dentists with the ultimate solution for quality practice, together with simplicity and flexibility.

Bibliography

1. Coachman C, Gurel G, Calamita M. The influence of tooth color on preparation design for laminate veneers from a minimally invasive perspective: case report. Int J Periodontics Restorative Dent. 2014 JulAug;34(4):453-9.
2. Koumjian JH, Holmes JB. Marginal accuracy of provisional restorative materials. J Prosthet Dent. 1990;63:639–42.
3. Giordano, R. and McLaren, E.A. Ceramics Overview: Classification by Microstructure and Processing Methods. Compendium of Continuing Education in Dentistry. 2010;31:682-684.
5. Vargas MA, Bergeron C, Diaz-Arnold A. Cementing all-ceramic restorations: Recommendations for success. J Am Dent Assoc. 2011;142(Suppl 2):20–4S.
6. 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.
7. Kavoura V, Kourtis SG, Zoidis P, Andritsakis DP, Doukoudakis A. Full-mouth rehabilitation of a patient with bulimia nervosa. A case report. Quintessence Int. 2005 Jul-Aug;36(7-8):501-10.
8.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.
9. Guess PC, Schultheis S, Bonfante EA, Coelho PG, Ferencz JL, Silva NR. Allceramic systems: laboratory and clinical performance. Dent Clin North Am. 2011 Apr;55(2):333-52, ix.
10. Rekow ED, Silva NR, Coelho PG, Zhang Y, Guess P, Thompson VP. Performance of dental ceramics: challenges for improvements. J Dent Res, 90 (2011), pp. 937-952.

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

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