Aesthetic Rehabilitation using Feldspathic Veneers

 

Smile enhancement involves synergy between pink and

white aesthetics. It is very important in complex cases to have

control of each procedure, namely, restorative, surgical and

laboratory, to achieve success in the whole rehabilitation.

The team of clinicians and the technician have many ways

of transforming the soft and the hard tissues predictably.

In this case, a 22-year-old female with an inclination

of the midline and gummy smile wanted to improve it.

Shifting the linear axes of the teeth and correcting the soft

tissues is a delicate procedure that must be very precise.

 

 

 

Initial photos of the patient showing the bilateral asymmetrical line of the gingiva.

 

 

 

In this case clinical crown lengthening was planned in order to resolve the asymmetry of the gingiva followed by full arch bleaching for 3 weeks.

 

 

 

In order to communicate with the patient, a mock up realization can play an important role for

the patient and the clinician to understand and visualize the final result.

 

 

 

 The correction of the midline and the linear axes of the teeth can be easily seen in the smile photos after the mock-up procedure.

 

 

The portrait of the patient after the mock-up procedure.

 

 

Enamel preservation is the key to porcelain-veneer success as the bonding in this tooth structure is the most durable. Preparation over the mock up can help reducing only the tooth volume needed for the technician to create thin feldspathic laminates. A special silicon index that allows midfacial visualization simultaneously to incisal reduction control is used to measure clearance from the ideal final shape.

 

 

Double cord impression technique was used in this case in combination with PVS impression material.

 

 

In order to transfer to the laboratory the horizontal plane and vertical midline of the face, the OneBite® system was used. This system consists of 2 straight bars that lock to each other and an arch.

 

 

 

Alveolar model with the plaster dies.

Alveolar model with the refractory dies.

Wash bake using pure transparent ceramic.

 

Correction of the opacity in areas where dentine is missing with opaque dentin ceramic.

Alveolar model with the plaster dies. Correction of the inclination of the mastication plane with dentin.

Final formation of dentin.

Fluorescent dentin.                            Opaque dentin.

 

                    Incisal opalescence.                   Blueish transparent interproximal. 

 

                            Mamelons.                             Fluorescent mamelons. 

 

        Final formation of the mamelons. Pure transparent to create dentinoenamel junction. 

 

Final formation of transparency. High value enamel on the line angles. 

 

Luster ceramic on the middle third of the teeth.

Transparent blue to create depth illusion on the middle third of the teeth.

 

 

Isolation of the field with rubber dam helped moisture control during the veneer adhesive cementation. After the procedure, the excess cement was removed using a scalpel n.12

 

 

Immediately after the rubber dam removal, the tissues are slightly irritated.

 

 

Initial situation.

 

 

Final result.

 

 

Final result lateral views.

 

 

 

 

Final profile 

Lateral views of the smile.

It is important for the maintenance of the therapeutic result to provide the patient with a night guard in order to protect the veneers.

In this case, an intraoral digital impression was taken and a splint was fabricated using CAD/CAM technology without any analog procedures.

 

MDT.

NONDAS VLACHOPOULOS

Nondas Vlachopoulos was born in Toronto, Canada.

He graduated from the school of dental technology in 1985.

He then acquired a BSc Hons from the School of Dental Technology of

the Technological Educational Institution of Athens (1989).

In 1990, he established his own dental laboratory "AestheticLab" in

Athens. Since 2001, he has been Opinion Leader for Noritake Dental,

Ivoclar Vivadent and MPF Brush Co. in Greece.

Since May 2014, he has been an editorial reviewer at the AACD’s

Journal of Cosmetic Dentistry (jCD).

He specializes in aesthetic all-ceramic and implant restorations.

His laboratory collaborates with the Dental School of the National

and Kapodistrian University of Athens, Greece and its postgraduate

programs of Dental Prosthodontics and Dental Surgery, as well as

with the Department of Prosthodontics of the Eastman Institute of

Oral Health of the University of Rochester, USA.

Since September 2015, he has been cooperating with the practical

education of the Postgraduate program leading to a Master of Science

Degree in Dental Biomaterials/Materials of Dental Technology.

The program is operated by The Department of Dental Technology of

the Technological Institution of Athens in conjunction with the Dental

School of the National & Kapodistrian University of Athens.

Nondas Vlachopoulos is leading many educational hands-on courses

in Greece and worldwide (USA, South America, Europe,

Asia and Middle East). He is invited to lecture on dental aesthetics at

international meetings and congresses. He has published articles

in Greek and international Dental Technology journals.

DR.

DIMITRIOS SPAGOPOULOS

Dimitrios Spagopoulos graduated as a dentist from the University of

Athens. In 2013 he continued his studies in the postgraduate program

of Operative dentistry at the University of Athens. At the same time

he has been working in the field of esthetic, restorative and adhesive

dentistry as a private practitioner.

In addition he has presentations in local and international conferences

as well as various articles on the subject of esthetic and restorative

dentistry.

ASSOCIATE PROFESSOR

EFSTRATIOS (STRATIS) PAPAZOGLOU

1989: Dental Degree, University of Athens

1991: Certificate in Prosthodontics and Master of Science,

The Ohio State University (OSU)

1999: Ph.D., Oral Biology and Biomaterials, OSU

Coordinator of the graduate clinic of Operative Dentistry at

the University of Athens

Owner of a specialized dental practice limited to Aesthetics,

Prosthodontics and Implant Dentistry.

Lectures nationally and internationally and has numerous

publications and abstracts in referred dental journals.

 

 

 

Sources:

Gurel G, Morimoto S, Calamita MA,

Coachman C, Sesma N

Clinical Performance of Porcelain

Laminate Veneers: Outcomes of the

Aesthetic Pre-Evaluative Temporary

(APT) Technique

Int. J Periodontics Restorative Dent,

2012 Dec, 32(6): 625-35.

Layton DM, Walton TR

The Up to 21-Year Clinical Outcome

and Survival of Feldspathic Porcelain

Veneers: Accounting for Clustering

Int J Prosthodont,

2012 Nov-Dec, 25(6): 604-12

Magne P, Belser U

Bonded Porcelain Restorations in

the Anterior Dentition: A Biomimetic

Approach

Quintessence Publishing Co, Inc. 2002

Peumans M, Van Meerbeek B,

Lambrechts P, Vanherle G

Porcelain Veneers: A Review of the

Literature

J Dent.

2000 Mar, 28(3): 163-77.

Peumans M, De Munck J, Fieuws S,

Lambrechts P, Vanherle G, Van

Meerbeek B

A Prospective Ten-Year Clinical Trial

of Porcelain Veneers

J Adhes Dent

2004 Spring; 6(1): 65-76.

Layton DM, Clarke M, Walton TR

A Systematic Review and Meta-

Analysis of the Survival of

Feldspathic Porcelain Veneers Over 5

and 10 Years

Int J Prosthodont

2012 Nov-Dec, 25(6): 590-603.

 

 

 

 

 

 We are very grateful to have been a part of Labline's publication.

 All rights of this publication go to Labline:

 

DENTAVANTGART LABLINE

VOLUME VI ISSUE 03 AUTUMN 2016

INTERVIEW

DR. SIDNEY KINA

DENTAL KNOWLEDGE

AND ZEN

DT. SÉBASTIEN MOSCONI &

DR. MARIE CLÉMENT &

DR. CYRIL GAILLARD &

DR. RENAUD NOHARET

DETAILED,

ILLUSTRATED

REVIEW OF THE

LIVE PATIENT

COURSE

MDT. NONDAS VLACHOPOULOS &

DR. DIMITRIOS SPAGOPOULOS &

DR. EFSTRATIOS PAPAZOGLOU

AESTHETIC

REHABILITATION

USING

FELDSPATHIC

VENEERS

A CASE STUDY

DR. JAVIER VASQUEZ

FUNCTION - THE

NEW DEFINITION

OF OCCLUSION