Pushing the Esthetic Button:
Veneer Rehabilitations in the Digital Workflow

A female patient presented in the dental practice because she was unhappy with the esthetic appearance of her smile. During her first clinical inspection, brown and white spots became visible on the vestibular surfaces of her front teeth. The initial caries lesions were the result of an orthodontic treatment with a fixed appliance. When the patient laughed, a gummy smile and a hypertrophic gingiva became noticeable on her upper incisors.

First of all, photo and video documentation was performed to fix the initial situation digitally. The disruptive factors were discussed and analyzed meticulously with the patient. Then a pre-preparation scan was performed with the intraoral 3Shape TRIOS scanner (3Shape, Denmark).

A frontal smile photo was taken on a tablet with the DSDApp by Christian Coachman. The face was measured according to the esthetic principles and an ideal virtual tooth morphology was created on the upper incisors and the two pre-molars in 2D. In the NemoDSD 3D software (Nemotec Software, Spain), the data of the intraoral scan and the Digital Smile Design were matched to create a virtual wax-up model. The designed ideal was printed three-dimensionally (Rapid Shape, Germany). A silicone index was fabricated with soft and heavy body silicone on the model. The index was sculptured meticulously with a scalpel, according to the garland-shaped gingival line of the printed model. Self-curing bis-acrylic resin for temporary crowns and bridges was applied to the silicone index which was then placed intraorally. The excess of the composite was removed easily in the gel-phase along the prepared silicone index. After setting the material, the silicone index was removed, and the virtually designed mock-up stayed on the upper dental arch. The mock-up was emotionally presented in a second photo and video shooting and discussed. Finally, the patient agreed to start with the definitive treatment.

Guided gingival surgery was performed with a scalpel along the mock-up margin to sculpture the new gingiva line according to the Digital Smile Design. Then a controlled mock-up veneer preparation took place with the aim to stay in the enamel tissue. A minimally invasive chamfer was established at the preparation margins on the incisors and the four premolars in the upper jaw. After finishing with a fine rubber polisher wheel, a second intraoral scan was performed.

The veneers were designed with VITA ENAMIC multiColor 1M1 HT with the CAD design software (3Shape, Denmark) based on the virtual wax-up.

Finally, the blocks were milled with the CORiTEC 250i milling unit (imes-icore, Germany).

Polishing was performed with the VITA ENAMIC Polishing Set and individual staining and glazing was accomplished with the light-curing VITA ENAMIC STAINS Kit. This dental material should not be fired, which is a big time-saving factor and allows to treat patients in only one visit. After a short clinical try-in, the veneers were conditioned with hydrofluoric acid and silane before they were full-adhesively cemented with composite.

The final esthetic result was documented in a third photo and video session during which the patient obviously felt very well with her new restorations. The veneers showed a natural play of light and colors and harmonized with her happy and self-confident personality. Pink and white esthetics presented with a perfect match. Compared to veneers fabricated on refractory dies, the digital workflow between lab and dental practice offered an efficient and fast progress with an excellent and esthetic result. The Digital Smile Design, combined with the multichromatic hybrid ceramic VITA ENAMIC multiColor, can therefore be seen as an economic and predictable alternative treatment in the field of esthetic dentistry, which will make cosmetic rehabilitations accessible to a larger group of people.