GAP Australasian-Dentist-Mar Apr 2019

Category 80 AustrAlAsiAn Dentist with the natural surroundings in the patient’s mouth. Glaze firing is therefore an important and critical firing process. it should be the result of the interplay between manual polishing, quality of gloss and the firing parameters (Fig. 13). Cementation and recall the crowns and veneers were placed adhesively using Variolink ® esthetic luting composite. this material is ideally suited for the permanent cementation of demanding ceramic restorations. excess composite was removed with the help of fine diamond burs, rubber finishers and polishers. Occlusal interferences were eliminated. At the first recall, the restorations were inspected and some last modifications implemented (Fig. 14). Conclusion Ceramic restorations have been used in cosmetic dentistry for over thirty years. Past experience has shown that the quality and longevity of these restorations depend to a considerable extent on the experience of the treatment team. Modern materials, however, are offering ever more reliability and flexibility. the restorations described in this report were re-inspected after approx. 4.5 years (Figs 15 and 16). they continued to be in very good condition, reflecting the effectiveness of the material and the manufacturing process. u Aiham Farah, MDT Cosmetic Ceramist, Trainer and Material Consultant Dubai, United Arab Emirates aihamfarah@gmail.com Anas Aloum, BDS, FACP Medical Director and Prosthodontist Abu Dhabi, United Arab Emirates anasaloum@yahoo.com situation. the crowns and veneers were therefore completed with the iPs e.max Ceram layering ceramic after they had been crystallized to attain a natural looking result, increase the translucency and achieve an optimum match in terms of depth, chroma, value and hue. initial characterizations were already applied to the cervical and interdental areas during the crystallization process (e.g. with iPs e.max CAD Crystall./shades). Transferring the preparation shade to the model the dentin shade of the tooth preparations had to be transferred to the model before the layering scheme and ceramic veneering materials could be selected. this is essential to keep a consistent shade match throughout the manufacturing process up to the insertion of the restoration. Model dies were created using iPs natural Die Material. even some of the existing orange spots on the dentin (e.g. cervical area of right central incisor) were reproduced on the model dies (using light-curing characterization materials from the sr nexco ® range). Finalizing the restorations Following a simple cut-back in the incisal third, a natural-looking transition was created between the layers using the iPs e.max Ceram Mamelon and Opal materials as well as a variety of brighter shades (Fig. 11). After firing, a great deal of care was invested in perfecting the texture, contours and surface characteristics (Fig. 12). At the end, the shade match was checked on the model dies. A variety of (try-in) materials can be used to adjust the brightness between veneers and crowns at the try-in and subsequent seating of the restorations. in addition, a natural- looking lustre blends in harmoniously Bl4 was appropriate for all restorations, which it was. so, the Mt Bl4 shade was employed for both the crowns and the veneers. Try-in and insertion After the grinding process, a clinical try-in was performed while the restorations were still in their blue intermediate crystalline stage (Figs 9 and 10). the evaluation was carried out with the dentist’s specifications and the patient’s expectations in mind. in this context, photos of the lips and face of the patient play an essential role for the quality of the technician’s work. Adjustments can be applied as required and the photos can be viewed from various angles. Layering OR staining? A straightforward and uniform result could have been achieved by simply glazing/staining and crystallizing the “blue” restoration in a single firing process. in this case, however, we are talking about an esthetically demanding Figure 9: Restorations in transmitted light prior to crystallization (blue stage): note the differences in material thickness Figure 12: Verifying the contours and microtexture with gold powder Figure 15: Restorations after six months. The restorations harmonize with the teeth in the lower jaw – the slightly lighter shade was requested by the patient Figure 10: Try-in of the restorations in the blue intermediate crystalline stage Figure 13: Examination on unsegmented model: closed interdental spaces after Glaze firing and manual polishing Figure 16: Restorations after 4.5 years: The four crowns and two veneers are durable, their shade has remained stable and the soft tissues surrounding them looks healthy. Figure 11: Restorations on the working model: restorations in the blue stage on one side and the result on the other, i.e. tooth-coloured restorations after crystallization and veneering with IPS e.max Ceram Figure 14: Result after four weeks. Note the soft feminine alignment of the teeth lInICal