DIRECT VENEERS- FROM DESIGN TO IMPLEMENTATION
Figure 5. After creating the mock-up, it is possible to do corrections intraorally upon the patient’ s request
Figure 6. Enamel prepared off to 45 degrees and the silicon key
Figure 7. The completed palatal enamel
Figure 8. Upon the patient’ s request, we wanted to give the frontal teeth a youthful characters and that’ s how we applied the dentin color shade, too.
Figure 9. Restoration after applying the enamel layer
2. Case report
In our example case, the patient was a 58-year old female, who visited the clinic with frontal teeth damaged by attrition. She had a good and stable periodontal situation, did not smoke and had no other illnesses. In terms of functional pathology, no abnormities were found, therefore no other treatment was necessary. We assume that abrasion had been caused by a previous( already removed) bridge in the lateral region and bruxism induced by it( Fig. 1). Our goal was to restore a harmonious smile, taking into account the principles of Visagismo. Based on intensive communication with the patient, we managed to find a balance between her requirements and what was feasible. After long talks with her, we chose the square tooth shape, being characteristic of a primarily“ phlegmatic” temperament, as the basis of the further stages of the design process( Fig. 2). It was inevitable to take the patient’ s age into
Figure 10. The character of the teeth matches the requirements of the original plan
account. Younger patients’ smiles are generally characterized by longer, rectangle-shaped central incisors, more marked edges, mamelons, HALO effects, visible perikymata and surface grooves, brighter colors, etc.( Fig. 3) These characteristics are different in older patients. Incisors tend to be shorter, and individual features( edge transparency, mamelons, HALO effect, perikymata, etc.) are significantly less or not at all visible on the teeth. 4 The diagnostic wax-up was produced by the dental technician with these in mind and computer-aided design. The visualization plan created was discussed with the patient in detail and we outlined the options to her. After the diagnostic wax-up, the silicone impression key was created in order to manufacture the intraoral mock-up( Fig. 4). 5 During the next session, the mock-up was created, which we used to demonstrate to the patient her later treatment options. By re-shaping the mock-
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