Veneer and crown restorations

The key to success with indirect restorations often lies in a minimally invasive approach. A 24-year-old dentist presented with a discolored upper left central incisor and upper right central incisor containing a small restoration with a metal pin. Additionally, the incisors exhibited asymmetry. To achieve a wider and more harmonious smile, a combined approach was chosen.

style italiano styleitaliano smile before restoration

Fig.1
The initial situation (frontal view of the smile) revealed an asymmetrical shape and shade in both central incisors, prompting the patient to seek an enhanced smile.

style italiano styleitaliano intraoral picture showing incisor discoloration

Fig.2
The initial situation, observed from the frontal view in occlusion.

style italiano styleitaliano x-ray suggesting need of root canal retreatment

Fig.3
Close-up view. From the X-ray, it was evident that the upper left central required endodontic retreatment.

style italiano styleitaliano occlusal view of the incisors to restore

Fig.4
Occlusal view. The metal pins from both centrals are to be removed, as well as the old composites.

style italiano styleitaliano initial preparation guides

Fig.5
A 0.5-mm depth-cutting bur was used during the initial phase of preparation by following the curvature of the labial surface.

style italiano styleitaliano marking pilot grooves

Fig.6
By using the pencil, I marked the depth created by the guide-bur.

style italiano styleitaliano anatomical flattening of preparation

Fig.7
A coarse diamond bur was then used across the whole buccal surface, and after thickness and the depth reduction, focus was put on the preparation design by following some basic rules:
– Respect of buccal convexity.
– Cervical margin location at 0.5 from free gingival margin.

style italiano styleitaliano opening contact point

Fig.8
Opening the contact between the teeth according to the parallelism of axial walls with slight tapering of the walls to achieve maximum retention.

style italiano styleitaliano removal of old composite and metal pin

Fig.9
A round bur was used to remove the metal pin and build the abutments back up. The cingulum was preserved by using a rugby-ball bur for palatal preparation.

style italiano styleitaliano finishing line preparation

Fig.10
Final preparation for veneer and crown. To evaluate the finish line, one should check from the incisal view before the final impression.

style italiano styleitaliano final preparation with first retraction cord

Fig.11
Final preparation of both centrals (veneer and crown).

style italiano styleitaliano shade selection for crown

Fig.12
Shade selection using the ND shade guide for the crown.

style italiano styleitaliano intertion of second retraction cord

Fig.13
Two retraction cords were placed for vertical and horizontal displacement of the gum.

style italiano styleitaliano removing retraction cord

Fig.14
The light body material is very flowable and able to fill all the space created by the second retraction cord, with the double paste technique it is also necessary to inject the material (light body) around the prepared teeth.

style italiano styleitaliano precision impression

Fig.15
Final impression.

style italiano styleitaliano bite registration

Fig.16
O-Bite simplifies the process of bite registrations for dentists, patients, and laboratories alike. This soft, non-gritty, thixotropic orange silicone material boasts a high final hardness, neutral taste, and a delightful orange scent, ensuring a patient-friendly experience. O-Bite is applied on both sides.

Once set, it transforms into a rigid material, preventing deformation and maintaining its perfect shape. O-Bite demands no specialized technique and won’t adhere to undercuts or existing restorations. After removing the registration from the mouth, a simple trim with a standard scalpel or bur, disinfection, and sending it off to the lab complete the process seamlessly.

style italiano styleitaliano o-bite silicone bite registration material

Fig.17
O-Bite, designed for bite registration, stands as an innovative and superior material, delivering outstanding accuracy, predictability, and efficiency. Tailored to produce more stable and precise bite registrations, it offers an extended working time, swift setting time, and the highest final hardness—qualities paramount for both dentists and laboratories.

dmg banner style italiano styleitaliano
dmg banner style italiano styleitaliano
style italiano styleitaliano index for provisional restoration

Fig.18
A silicone index was fabricated using both a putty and a light body (DMG Honigum Putty Soft Fast and Honigum Pro Light Fast). To create a provisional restoration, Luxatemp Star was placed inside the index key directly with the mixing tip. The index was cut with a surgical blade to achieve upper arch indices.

style italiano styleitaliano injection of luxatemp provisional material

Fig.19
The first impression was then filled with a self-curing resin material (DMG Luxatemp Star) in order to create a temporary restoration for the prepared tooth. DMG Luxatemp Star resin was applied inside the silicone index without removing the mixing tip from the silicone index until all the teeth were filled, in order to prevent internal voids.

style italiano styleitaliano fabrication of provisional restoration

Fig.20
After placing the index in the mouth, we had to wait for the gel phase before removing excess material. It is advisable to keep the index in the mouth for two more minutes before removing it for polishing procedures.

style italiano styleitaliano provisional restoration after finishing

Fig.21
Upon removal of the index from the patient’s mouth, it is essential to perform finishing and polishing procedures to eliminate any sharp edges, particularly in the inter-dental papillae region. This step aims to create space for papilla enhancement.

style italiano styleitaliano lithium disilicate veneer and crown

Fig.22
Lithium disilicate (e-max) ceramic veneer and crown were fabricated by the dental lab.

style italiano styleitaliano conditioning of lithium disilicate

Fig.23
HF 9% was applied on the internal surface of the glass ceramic restorations and LuxaBond Universal (DMG) was applied on the glass ceramic veneer internal surface.

style italiano styleitaliano vitique resin cement

Fig.24
Vitique is a premium cementing system for complicated veneer work. The light-curing, composite-based cements are available in a wide range of shades. Matched try-in pastes corresponding to each shade provide a dependable preview of the ultimate outcome. For cementation, an aesthetic resin cement (DMG Vitique White) was employed.

dmg banner style italiano styleitaliano
dmg banner style italiano styleitaliano
style italiano styleitaliano final restorations in place and post-re-treatment xray

Fig.25
Final situation (close-up side view) of the patient with periodical x-ray after root canal retreatment.

style italiano styleitaliano situation after final restoration

Fig.26
Final situation.

style italiano styleitaliano final incisor restorations in occlusion

Fig.27
Final situation, in occlusion.

style italiano styleitaliano smile after final restorations

Fig.28
Both the dentist and the patient were very happy with the final aspect.

Conclusions

The selection of materials plays a crucial role, and in this instance, a bite record was utilized—specifically, the O-Bite registration material from DMG. The material’s precision significantly minimizes or eliminates chair-side occlusal adjustments to restorations, saving valuable time and ensuring enhanced patient comfort. It is both non-technique sensitive and a hard VPS-based bite registration material.

Additionally, the resin cement employed was DMG Vitique, available in a wide range of shades to suit all esthetic needs. Its special veneer-dedicated tip facilitates easy and controlled application of the cement. Moreover, it features try-in pastes with a matching colors, allowing for a meticulous color match check in challenging cases before the final cementation of veneers.

Bibliography

  1. Galip G. The science and art of Porcelain Laminate Veneers , London, Quintessence, 2003.
  2. Koubi S. Laminate veneers. 2020 Quintessence.

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