Highly Esthetic Gap Closure with Personalized Press Ceramics

The male patient was 25 years old and generally dissatisfied with his smile and the appearance of his upper anterior teeth. He had high esthetic expectations. The clinical inspection presented multiple irregular diastemas in the intercanine maxillary region caused by localized microdontia and a typical rotation of both lateral incisors. The incisal edges and canine cusp tips of the upper anterior teeth were moderately worn and pronounced on the right side. As a result, there was no incisal translucency. Situation impressions were taken in order to be able to determine the ratio of the anterior teeth on the upper and lower jaw on diagnostic models, and to analyze if orthodontic treatment could be an option for gap closure. After orthodontic treatment turned out to be insufficient, all-ceramic veneers were selected for the esthetic zone.

The shade determination with the spectrophotemeter VITA Easyshade V is proven to be more precise than with the human eye. In this case, a meticulous tooth area shade determination was peformed in the neck, central and incisal areas of all anterior teeth in the upper and lower jaw. Due to the data of the shade gradient, the basic shade 2M2 was determined in the VITA SYSTEM 3D-MASTER, which is correspondent to an A2 in the VITA classical A1–D4 system. An esthetic wax-up with an ideal esthetic morphology was created on the upper diagnostic model. A partial silicone impression was taken from the wax-up and used clinically to transfer the ideal situation with flowable composite as a mock-up to the patient’s mouth.
The result was discussed and changes were made by grinding or adding flowable composite material. After all persons involved agreed on the desired result, a situation impression was taken of the ideal situation. In order to be as minimally invasive as possible and stay in the preferred enamel area for the full-adhesive cementation, this was followed by a mock-up preparation. Precision impressions were taken of the upper and lower jaw and provisionalization was carried out with the help of the silicone matrix and flowable composite material.

To satisfy the young patient’s request for a superior esthetic result, and to reproduce the appearance of natural teeth, the most individual technical approach was selected using glass ceramic copings made of the pressable ceramic VITA AMBRIA. The material choice provides predictive shade management according to the VITA shade systems, durable results and high esthetics, due to a natural translucence, opalescence and fluorescence. The fabricated master models were scanned in the laboratory, and copings were designed virtually in the CAD software and milled in wax. The wax copings were invested, burned out and pressed using VITA AMBRIA A2-T pellets in the VITA VACUMAT 6000 MP furnace. The elaborated copings were veneered with VITA LUMEX AC, which offers individual and shade-accurate light dynamics. The first dentine firing was carried out with OPAQUE DENTINE A3,5 and A3 and DENTINE A3 and A2, plus effect materials TRANSLUCENT, OPAL TRANSLUCENT and MAMELON. The second firing was realized with ENAMEL light and clear. The glaze firing took place with VITA AKZENT Plus Glaze LT Powder after finishing. 

During the clinical try-in, the dynamic and static function of the veneers, the gingival relation and the achieved shade in the patient's mouth were also checked. The length of the canines and incisors was minimally reduced and accordingly polished. For the fully adhesive integration, the 2M2 cement shade of the VITA ADIVA FULL-ADHESIVE luting system (VITA Zahnfabrik, Bad Säckingen, Germany) was selected to achieve a perfect match to the shade of the veneers and to avoid any possible shade interference on the final restorations. This case demonstrates how fundamentally important shade accuracy between shade guide, framework, veneering material and luting composite is in order to systematically achieve the desired all-ceramic result in a patient-specific manner. Esthetics and function were accomplished and the patient was completely satisfied with the final result.