Fig.1
A 24-year old female’s smile, came to the office complaining the aspect of her old composite veneers. We found out that she had suffered an accident on the playground during her childhood, leading to fracture of teeth 11 and 21 in the incisal edge. The teeth were directly restored with composite many times, but she still wasn’t happy about the shape and general aspect of the other teeth. After informing the patient about the advisability of an orthodontic treatment, she explained she wanted a result in a shorter time span, so we decided to go for lithium disilicate veneers for all the 6 frontal teeth. This option allowed for a slight correction of her misalignment, shape correction, and color improvement.

Fig.2
Frontal view with the retracted lips. You can notice the misaligned teeth, the old restorations, and the diastema between 21 and 22.

Fig.3
The models mounted in an semi-adaptive articulator Artex CR (Amann Girrbach) in a centric relation.

Fig.4
After examining protrusion and laterality movements, we could highlight a few interferences.

Fig.5
The diagnostic wax-up was followed by the mock-up. In order to correct the misalignment, some enamel needed to be removed from teeth 13, 11 and 21.

Fig.6
Preparation through the mock-up with a preset bur of 0.5 mm was the most conservative way to start. The whole preparation was made under magnification.

Fig.7
Impressions were taken with a polyether (Impregum Penta Soft – Medium Bodied Consistency, Garant LDuo Soft – Light Bodied Consistency, 3M) and checked under the microscope for possible interferences like air-bubbles.

Fig.8
The six E-Max veneers.

Fig.9
Veneers of 11 and 21. In the cervical area the thickness of the veneers was 0.3 mm.

Fig.10
The veneers were etched with 9% hydrofluoric acid for 20 seconds and then rinsed.

Fig.11
To achieve a clean surface of the veneers and for residue removal, additional etching was performed with 37% phosphoric acid for one minute. After this, the veneers were cleaned for one minute with running water, dried with air and skimmed with alcohol 90%.

Fig.12
The silane was applied with a brush and air dried to help the alcohol evaporate.

Fig.13
The rubber dam was applied in order to achieve perfect isolation. With a spatula and dental floss, the rubber dam was inverted into the gingival sulcus.

Fig.14
Steps from the cementation process. Teflon tape was applied to the neighboring teeth in order to protect them from over-etching. Each tooth was etched for 30 seconds, then rinsed and dried. After the etching process, all the following steps were made under the UV filter from the microscope. The Variolink Esthetic kit (Ivoclar Vivadent) for veneer cementation was used. Bonding was applied in a thin layer and air-blown for a few seconds. Each veener was loaded with the light-curing cement (Light shade was chosen from the kit) and fit into place. The excess material was removed with a brush, and double checked for a perfect fit. The polymerization was made for 40 seconds on each side.

Fig.15
After placing the veneers.

Fig.16
At check-up.

Fig.17
The initial situation.

Fig.18
Two years post-op. The veneers are fully integrated and no inflammation of the gingiva was found. The patient was truly delighted with the result and she periodically comes for the recommended check-up.

Conclusions

The concept of minimally invasive dentistry means the use of optic microscope and it’s really helpful to conserve better the healthy dental tissue and that is the key of long-term success restorations. Magnification is important when trying to be minimally invasive, especially when the cervical area is involved. When preparing this area, magnification helps reduce the risk of hurting the gingiva, bleeding at the marginal sulcus, and also allows for a perfect finish to the preparation. The final cementation was performed using rubber dam and magnification for maximum precision, durability and excess removal.

A special mention goes to Conf. Dr. Leretter Marius, under whose coordination this case was performed.

Bibliography

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