RESTORATIVE CHALLENGE: A 29-year-old male patient presented with a large midline diastema, a diastema distal to each lateral incisor, several misaligned teeth and a negative buccal corridor space (see Figure 1). The patient had never corrected these esthetic deficiencies due to his dental phobia, but came in for a consultation after seeing an ad for no-prep veneers.
Restorative team: Ceramist Cindy Lam and Dr. Michael DiTolla, both of Glidewell Laboratories, Newport Beach, California
Treatment plan: The patient was seen for the initial consultation and study models were fabricated. The study models were evaluated using an orthodontic archwire to help determine the proper arch form.
Since none of the teeth in the upper arch fell more than 1.5mm facial to the orthodontic archwire, the team decided that the patient was an acceptable candidate for Prismatik ThinPress no-prep veneers on teeth #4-13. Since the material can be pressed as thin as .3mm (see Figure 2), in many cases it can correct esthetic problems without tooth reduction. The material has an inherent fracture strength of between 150-165MPa, which allows for grinding and finishing of the facial contours with more confidence then when handling traditional ceramics. In addition, the unique chemistry of Prismatik ThinPress combines leucite and feldspathic ceramics to provide the benefits of both.
Case study: The patient's teeth were pumiced and final impressions were taken with a full arch metal tray and a two-phase polyvinylsiloxane impression material. The final impressions were forwarded to laboratory technician Cindy Lam who had already seen the diagnostic models and given her approval to proceed with a no-prep approach. The models were poured and mounted on an articulator and the maxillary model was trimmed so that veneer fabrication could begin.
Lam carefully waxed the patterns to the final shape of the veneers (see Figure 3), then sprued, invested and pressed according to typical pressable ceramics. She was particularly careful during the divesting process since sandblasting ceramic of such thin dimensions can be difficult (see Figure 4).
Lam finished contouring the restorations and glazed and polished them to a high shine (see Figure 5). Dr. DiTolla tried in the veneers individually to check the fit and evaluate cervical contours, tried them in together to evaluate contacts and then tried them in with a translucent veneer try-in cement so they didn't look opaque.
The teeth were pumiced and etched with 37% phosphoric acid. Optibond was placed on the tooth, air-thinned and light cured. The internal aspect of the veneers had been etched in the laboratory with 10% hydroflouric acid and after the water-soluble try-in paste was rinsed out of the veneers, they were cleaned with a 37% phosphoric acid.
Dr. DiTolla then placed the translucent shade of Appeal resin cement in the internal of the veneers and placed them onto the teeth. Using a curing light, each veneer was cured for approximately three seconds. This allowed him to clean the majority of the excess cement in the gel state with an explorer. After the final curing of the veneers, the occlusion was adjusted where necessary and the restorations were polished.
In addition to closing the patient's diastema and lengthening the incisal edges, a permanent shade change was also achieved (see Figure 6). The patient accepted the veneers immediately upon try-in and, upon final placement, was completely satisfied with his new smile.
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