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 )