DIRECT VENEERS- FROM DESIGN TO IMPLEMENTATION
Figure 11. The completed restoration
Figure 13. Six-month checkup. Teeth 21, 22 showed that the closure line at the edge had become minimally visible
up, it was possible to finalize the planned shape.( Fig. 5) 2.1. Preparing the teeth After obtaining the desired shape, we prepared a silicon key intraorally for the final restoration. Thereafter, we carefully removed the composite material used for the mock-up. We chose the A3 tooth shade by using Vita Classic shade guide. We put- whitout adhesive technique- a minimal amount of the appropiate dentin and enamel on the tooth, which were removed after reviewing the shade. After that we prepared the enamel edges off to 45 degrees( Fig. 6). An important step is to select the appropriate tooth color shade before isolating, before the tooth material dehydrates. Thereafter, the dental rubber dam, which is essential in such restoration works, is put into place. We conditioned the surface by means of total etch technology- 37 % orthophosphoric acid for 40 seconds, Adper Single Bond 2 Adhesive( 3M ESPE, St. Paul, MN 55144-1000, USA). 6
2.2. The composite layering technique The first step was to put the palatal enamel to teeth upper right and upper left central and lateral incisor( Filtek Ultimate A3 Enamel, 3M ESPE, USA). We used a vertically cut silicon block in the process( Fig. 7). Upon to the patient’ s request, we intended to give a youthful character to the frontal teeth- we applied the dentin color shade accordingly( Filtek Ultimate A3 Dentine, 3M ESPE, USA). 7 We believed that any more marked edge transparency or HALO effect was not necessary, so we could proceed to the application of buccal enamel( Fig. 8). 8 During
Figure 12. The relative widths of the teeth can be evaluated. It is visible that the ratio of the large and small incisors complies with the“ golden standard” and the relative width of the two canines is larger than the“ golden standard”
the application of enamel layers, we used Teflon tape to isolate the individual teeth from each other( Fig. 9). Using a silicon brush( Micerium S. p. A, Avegno( Ge), Italy) was a great help for us in working out the surface. The sticking of the brush can further be reduced using Composite Primer( GC, Tokyo, Japan). 9 Special care must be taken not to break the morphologic elements of existing tooth material in the restored part but to“ continue” them carefully( Fig. 10). 10 2.3. Lifelike shaping of the characters and polishing The characters were created in a lifelike way during finishing / polishing. As a first step, we used FG mounted Arkansas stone at 40,000 RPM with water cooling to create the above-mentioned morphologic elements, correct the routing of marginal ridges and create the final shape of the surfaces. To polish approximal area, we used Super-Snap( Shofu Dental Corporation, Kyoto, Japan) disks. 11 Then, we reworked the surface using FG mounted Arkansas stone at low RPM and 3-micron polishing paste- SuperPolish( Kerr SA, Bioggio, Switzerland). The final polishing was carried out with the appropriate steps of the ENA Shiny polishing system( Micerium S. p. A( Ge), Avegno, Italy). 12 Studying the complete restoration, the relative widths of the teeth can be evaluated. It can be seen that the ratio of the large and small incisors meets the „ golden standard“( Fig. 11). 13 The relative width of the two canines is larger than the“ golden standard” value, but the dominant canines do not have any disconcerting effect on the patient’ s smile( Fig. 12). 14 At the six-month checkup, the clinical situation was as follows( Fig. 13). The patient was completely satisfied with the restoration( Fig. 14). At the examination, we found the restoration to be intact; the closure line at the edge had become minimally visible at teeth upper left central and lateral incisor. We removed this by polishing( Super-Snap, Shofu Dental Corporation, Kyoto, Japan) by replacing the upper lateral bridges on both sides, we created an esthetic smile that met the requirements of our patient, too( Fig. 15).
3. Discussion
36 STOMA. EDUJ( 2016) 3( 1)