Dental Asia Nov/Dec 2018

User Report DENTAL ASIA NOVEMBER / DECEMBER 2018 40 Achieving More with Less By Carola Wohlgenannt, MDT, Dornbirn/Austria In this clinical case, find out how lab-fabricated non-prep veneers made it possible for orthodontic treatment to be sidestepped. Despite the limited space available, brilliant shade dynamics were achieved with the help of specially shaded Enamel and Effect materials (IPS e.max Ceram Selection). “L ess is more”. However, using less is often difficult. Thanks to a high demand for minimally invasive restorations, dental technicians are presented with new challenges in their cases. The extent of the preparation is often reduced to minimise the invasiveness of the treatment, leaving only limited space for the fabrication of an aesthetically pleasing and functional restoration. Such situations necessitate adequate ceramic materials and experience to reproduce the subtle interplay of shades seen in natural teeth. While previously various ceramic powders had to be combined with each other to create the required mixture, this procedure has now been simplified with the introduction of new ceramic materials. The IPS e.max ® CeramSelection comprises specially shaded Enamel and Effect materials with brilliant shades and natural-looking light-optical properties. The range includes 12 shades which are divided into three groups. Six Special Enamel shades are designed to produce lively translucent effects in the enamel area, while three Light Reflector Effect materials have light-reflecting capabilities and are suitable for areas where a high brightness value is desired. Lastly, three Light Absorber materials with light- absorbing properties are used to increase the in-depth effect. With this variation in materials, imitating natural teeth with individual characteristics is much easier than before. The range of possibilities is particularly convenient in cases where space is limited, such as in very thin restorations (e.g. veneers). Clinical case The approximately 40-year-old patient wanted the position of her teeth corrected (Fig. 1). She consulted her dentist with regards to this problem. She rejected orthodontic treatment mainly because of high costs, long treatment time and limitations during therapy. An orthodontist had recommended the extraction of a tooth in the lower jaw to compensate for the crowdedness and to provide the basis for orthodontic treatment. However, the Fig. 1: Incisal view of the preoperative situation patient was not in favour of this treatment method. She emphasised her desire for no tooth structure to be removed for the aesthetic correction. Treatment plan and mock-up The possibilities of an aesthetic improvement in the upper jaw were discussed together. In particular, teeth 11 and 13 were responsible for the misalignment in the dental arch. The teeth were inclined from the axis towards the palatal. The idea was to use two ceramic non-prep veneers to correct the misalignment and achieve harmony in the dental arch. With the help of a studymodel, the ideal tooth position was established in wax (Fig. 2) and then converted into “fast and easy” resin veneers (mock-up). The first impression after the placement of the mock-up was positive, which saw the patient agreeing to the suggested treatment. The existing chalky spot on tooth 21 was masked with composite in the dental practice. Challenge: reproducing the shade of the natural tooth The shape and morphology of the veneers were defined by the mock-up. Now, a matching tooth shade for the ceramic materials had to be determined. The challenges were posed by the dynamic interplay of shades, the “beautiful” translucency of the natural anterior teeth and the limited space available. How can the light-optical properties be reproduced as perfectly as possible in only a wafer-thin layer of ceramic material? The Enamel and Effect material concept of IPS e.max Ceram Selection provided the solution to this conundrum. First, the basic Fig. 3: Selecting the basic tooth shade (Dragon Shade, Drachenberg & Bellmann) Fig. 2: Mock-up in wax placed on the model