CATEGORY AUSTRALASIAN DENTIST 71 CLINICAL As with any intervention at this level, the decision to introduce gingival ceramic must be deliberate, discussed, and clinically validated – often through provisional assessment, such as controlled application of pink composite during the provisional phase – before being transferred to the definitive prosthesis. In this case, while site-specific bone grafting successfully restored hard- and soft-tissue volume, reproduction of the interdental papilla in the interproximal region required a prosthetic solution. This was carefully planned and executed as part of the final ceramic build-up to achieve a harmonious and natural aesthetic integration. It was at this refinement stage that e.max Ceram Art became particularly relevant. Rather than replacing an established ceramic system, Ceram Art functions as a complementary refinement layer. The combined use of Ceram Art Illusion and Ceram Art Structure allows optical modulation and physical architecture to be addressed independently, expanding the expressive potential of the restoration without disrupting an existing workflow. A key advantage of Ceram Art lies in its material compatibility. Despite being part of the Ivoclar ecosystem, both Illusion and Structure integrate well with a wide range of ceramic systems on the market due to their adaptable coefficient of thermal expansion. In this case, they were layered directly over Noritake CZR without compromise. The firing protocol further supports this integration, operating at a significantly lower temperature than the primary CZR cycle, allowing refinement to be added with minimal risk of disturbing the underlying ceramic architecture. From a behavioural standpoint, the Structure material offers an additional advantage. Its handling characteristics – stable yet mouldable – allow controlled sculpting of micro-anatomy and subtle shape refinement in a manner that feels closer to composite than conventional ceramic powders. This proved essential in this case, where the adjacent natural dentition exhibited nuanced surface texture and transitional anatomy that could not be convincingly replicated through colour application alone. In an era where monolithic restorations risk visual homogenisation, the selective use of structure and illusion ceramics provides a means of restoring individuality to ceramic work. For ceramists seeking to differentiate themselves at a higher level, this approach offers a practical and controlled pathway to elevate outcomes – bridging digital efficiency with handcrafted refinement, without compromising biological, functional, or aesthetic principles. Try-in and Clinical Evaluation: The clinical try-in proceeded smoothly and predictably, confirming the accuracy of fit, overall aesthetics, and integration with the surrounding dentition. Both the seated evaluation and initial visual assessment aligned well with the objectives established during the planning and fabrication stages. As is often the case during try-in appointments, the use of local anaesthetic resulted in a temporary alteration of soft-tissue appearance, with the gingival tissues appearing lighter than their resting condition. While this is a normal and unavoidable clinical variable, it can limit the precision with which soft-tissue colour transitions are assessed at that specific moment. Rather than viewing this as a limitation, this stage highlighted an important consideration for future case planning – particularly when gingival ceramics and soft-tissue illusion play a role in the final aesthetics. One option in such cases is provisional or short-term temporary cementation of the restoration, allowing the tissues to return fully to their natural state before definitive aesthetic evaluation. Figure 17: CAD/CAM designed restorations on 14-12 Figure 18: Modified e.max ZirCAD Prime Framework Figure 19: Layered ceramics without shape adjustment Figure 20: Semi-completed restorations (with Noritake CZR) Figure 21: Application of e.max Ceram Art Illusion (after firing) Figure 23: Application of e.max Ceram Art Structure (after firing) Figure 22: Application of e.max Ceram Art Structure (before firing) Figure 25: Try-in before (Stump Shade photo) Figure 24: Completed restorations (after polishing) Figure 26: Try-in after (seated with a Try-in paste)
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