Page 20 - Dental Technology June 2022

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20 cosmetic section DENTAL TECHNOLOGY, APRIL-JUNE 2022

REPRODUCING VIBRANT LIGHT

DYNAMICS WITH VENEERING CERAMIC

ANTONELLO MARIA MESSINA AND MICHELE PROSPERINO

“Everything should be made as simple as possible, but no simpler,”
claimed world-renowned physicist and Nobel Prize laureate Albert
Einstein.
The same is true of ceramic reproduction. Layering should be as
simple and efficient as possible, so that it doesn’t seem too fussy or arti-
ficial. However, simplicity also has its limits if you want to reproduce
the complexity of nature in a highly esthetic way. Veneers fabricated on
fireproof dies using veneering ceramic must harmonize in the narrow-
est of spaces with the underlying enamel and dentin, and at the same
time reproduce the individual nuances and effects of the patient’s den-
tition that are consistent with the impression of the natural hard tooth
substance.
To achieve harmony, the remaining shade effect of the tooth – the
precisely determined basic tooth shade – should be confirmed and sup-
ported as simply as possible. For enamel layering, creativity and a lit-
tle more complexity are required in order to use targeted refraction,
reflection, absorption and transmission of light to reproduce a multi-
faceted result that is worthy of the natural teeth. To achieve this, the FIG 1: Initial situation with gaps and discoloration in the upper incisal dentition.
ceramic veneering system and the layering concept should be as logi-
cal and as simple as possible. Shade accuracy to the determined tooth
shade is the basis for successful ceramic layering. Imagination and
craftsmanship are then the key to achieving the required complexity of
natural variety without overdoing it.

CASE STUDY
A 39-year-old patient presented in the practice because she was unhap-
py with her smile, and in particular, with the shape and shade of her
four upper incisors. When her medical history was taken, the patient
spoke about prior orthodontic treatment as a 32-year-old that had last-
ed two years. She had also undergone periodontal surgery as a 37-
year-old, due to aggressive periodontitis. FIG 2: The target situation was defined in advance using a wax-up.
A class II malocclusion was diagnosed during the clinical examina-
tion. The upper anterior region was flared due to multiple diastemata.
The interdental papillae were missing in the esthetic zone, so that
black triangles were apparent in the approximal cervical area when
smiling. Significant brown discoloration was also evident on the upper
incisors. The incisal edge on tooth 21 was fractured, which created an
inconsistent incisal edge contour.
The patient wanted quick treatment that would level the tooth arch
and the tooth morphology, as well as close the black triangles and
remove the discoloration. She did not want any further orthodontic
treatment. After extensive consultation, she favored functional and
esthetic reconstruction of 12 to 22 with custom veneers fabricated on
fireproof dies.
DIAGNOSTICS FIG 3: A silicone key was created on the wax-up for intraoral transfer of the target situation.
Further diagnostics and planning were needed to show whether this
purely dental modification was appropriate to meet all of the patient’s
wishes with regard to optimal pink and white esthetics. For this reason,
the case was first analyzed within the team of dentists and dental tech-
nicians.
Using a situation impression, a model of the upper jaw was fabricat-
ed and an idealized wax-up was carried out. The wax-up was dis-
cussed, finalized and a two-step impression fabricated in silicone. The
silicone key of the target situation was then reduced (scalloped) along
the gingival margin using a scalpel. Flowable composite for temporary
crowns and bridges was poured into the silicone key, which was repo-
sitioned intraorally so that the target situation could be transferred to
the patient’s mouth. During the gel phase, it was possible to scrape off FIG 4: The mock-up was modified intraorally in accordance with the patient’s wishes.