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CERECDOCTORS.COM
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QUARTER 2
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2016
C A S E S T U D Y
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B Y D R . A K I N A L A D A G
it iswell established that there is an increasing demand for esthetic dental treatment around theworld.
However, the awareness that healthy, natural tooth structure should not be sacrificed for cosmetic enhancement is growing as well.
The path toward minimally invasive esthetic restorative treatments was paved by innovative restorative materials processed
using CAD/CAMtechnology. Among thesematerials, glass ceramics and hybrid ceramics (such as VITAENAMIC) areworthmentioning.
In my opinion, the latter category is even better suited for the following described patient case.
Producing Prep-less Veneers
Using the New VITAENAMIC
Minimally Invasive Esthetic Restorations
PROPERTIES OF A HYBRID CERAMIC MATERIAL
VITA ENAMIC is indicated for single-tooth restorations. It
consists of a dominant, fine-structure feldspar ceramic matrix
enrichedwith alumina and reinforced by a polymer network. Both
networks interpenetrate each other, resulting in a material that
combines the properties of ceramics and composites. The share
of anorganic ceramic in the material amounts to approximately 86
percent by weight.
What is especially advantageous for the fabrication of restora-
tions which allow a minimally or non-invasive preparation — e.g.
veneers — is the higher elasticity of hybrid ceramics as compared
to glass ceramic materials. This property ensures a very high-
load capacity and an improved machinability. After milling, the
edge stability of the restorations is high even when the mate-
rial thickness is low — which is usually the case with non-prep
veneers.
The following patient case is used as an example to show how
VITA ENAMIC may be used to produce non-prep veneers in a
simple and quick procedure.
INITIAL SITUATION
The 24-year-old male patient visited the Department of Prosth-
odontics at Ege University School of Dentistry in Izmir, and
presented with a concern about the appearance of his maxillary
anterior teeth (Fig. 1). It was evident that a closure of his multiple
diastemata was necessary to obtain a more esthetic look.
The first treatment plan suggested the placement of conven-
tional laminate veneer restorations requiring minimal tooth
preparation. However, since the patient was reluctant to sacrifice
healthy tooth structure, a new proposal was made. The new plan
was to produce six prep-less veneer restorations using CAD/CAM
technology. VITA ENAMIC became the restorative material of
Fig. 1: Initial situation: Multiple diastemata are visible
choice because of the beneficial mechanical properties and good
processability of this hybrid ceramic.
PREPARATIONS
After radiological evaluation, a conventional impressionwas taken
and a stone model produced in the dental laboratory. The shade
of the teeth was determined using VITA Easyshade Advance 4.0,
resulting in the shade 1M2. In order to provide for a complete
optical closure, the less translucent version of the material was
selected.
On the basis of the stone model, a wax-up was created for teeth
#13 to #23 (FDI-system) to develop the definitive contours of the
planned veneer restorations (Fig. 2). Then, the wax-up was used
to produce amock-upmade of acrylicmaterial. An impressionwas
taken on the model and filled with the material for temporaries.
The tray was subsequently placed in the patient’s mouth and the
mock-up fabricated for an individual assessment of the obtained
tooth shapes and shades (Fig. 3).
Because the teeth were still visible when he was smiling, the
patient expressed preference for a more comprehensive approach
that included veneer restorations for the first premolars in the
maxilla as well. As a result, the wax-up was altered to eight hybrid
ceramic veneers from tooth #14 to #24.
