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.

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

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.

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

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

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

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

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.

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.

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

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

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

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

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

Fig.16
Labial reduction according the depth marks.

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).

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

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

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.

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

Fig.22
After finishing and polishing the final preparations.

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.

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

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

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.

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

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

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

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

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.

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

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.

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