case_images: PMC6305029_01
case_images: (a) Initial photo of patient's right side. (b) Initial photo frontal view. (c) Initial photo of patient's left side.
case_images: CRID2018-5368939.001.jpg
case_images: PMC6305029_01_CRID2018-5368939.001.jpg
case_images: fig1
case_images: Patient R.C., 52-year-old male subject, sought for dental treatment demonstrating dissatisfaction with the upper anterior teeth aesthetics, which had extensive composite resin restorations, pigmentation, spots, and infiltration (Figure 1).
case_images: (a) Initial X-rays. (b) Initial study models.
case_images: CRID2018-5368939.002.jpg
case_images: PMC6305029_01_CRID2018-5368939.002.jpg
case_images: fig2
case_images: After the anamnesis, as well as the X-rays, photographs and upper and lower arches' evaluation (Figure 2), the case was prepared and an aesthetic rehabilitation treatment was proposed, consisting of a ceramic crown, with zirconia infrastructure in element 15 and laminated veneers, with feldspathic ceramics in elements 11, 12, 13, 14, 21, 22, 23, 24, and 25.
case_images: (a) Digital smile design. (b) Wax-up upper arch.
case_images: CRID2018-5368939.003.jpg
case_images: PMC6305029_01_CRID2018-5368939.003.jpg
case_images: fig3
case_images: Following the references from the digital smile design, which is performed using pictures of the face and smile of the patient and a computer program, PowerPoint (Microsoft) or Keynote (Mac), it is possible to correct positioning and minor glitches using smile lines and median with teeth proportionality; a diagnostic wax-up of the upper model was produced (Figure 3), and based on it, silicon guides were made to create the mock-up, guide the enamel/dentin preparation, and subsequently assist in the preparation of a temporary crown with bis-acryl resin.
case_images: (a) Silicone guide on the wax-up model. (b) Silicone guide cut along the long axis of the tooth. (c) Preparation using the guide. (d) Preparation finalized.
case_images: CRID2018-5368939.004.jpg
case_images: PMC6305029_01_CRID2018-5368939.004.jpg
case_images: fig4
case_images: Considering tooth 15, a metal-free preparation was made to cover the full crown with zirconia infrastructure; elements 14, 24, and 25 were chosen for inverted-type 4/5 preparations, and for the anterior teeth, tooth preparation for laminated veneers with incisal wear and no overlap was considered for the treatment (Figure 4).
case_images: Mold.
case_images: CRID2018-5368939.005.jpg
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case_images: fig5
case_images: A-silicone was positioned (Flexitime, Heareus Kulzer) (Figure 5). After analyzing the mold quality, the temporary crowns were prepared with A3-colored bis-acryl resin (Structur, Voco), using the silicone guide built on the model with diagnostic wax-up (Figure 6).
case_images: (a) Silicone mold filled with bis-acryl resin. (b) Temporaries in position.
case_images: CRID2018-5368939.006.jpg
case_images: PMC6305029_01_CRID2018-5368939.006.jpg
case_images: fig6
case_images: A-silicone was positioned (Flexitime, Heareus Kulzer) (Figure 5). After analyzing the mold quality, the temporary crowns were prepared with A3-colored bis-acryl resin (Structur, Voco), using the silicone guide built on the model with diagnostic wax-up (Figure 6).
case_images: Die-cut model.
case_images: CRID2018-5368939.007.jpg
case_images: PMC6305029_01_CRID2018-5368939.007.jpg
case_images: fig7
case_images: The working model was obtained using stone rock type IV (Elite Rock, Zhermack) and then punched (Figure 7) through the Accutrac system (Coltene/Whaledent), in laboratory, for later duplication and confection of the veneers in feldspathic ceramics (IPS Empress II, Ivoclar Vivadent) (Figure 8).
case_images: (a) Finished parts in the die-cut model. (b) Veneers in feldspathic ceramics.
case_images: CRID2018-5368939.008.jpg
case_images: PMC6305029_01_CRID2018-5368939.008.jpg
case_images: fig8
case_images: The working model was obtained using stone rock type IV (Elite Rock, Zhermack) and then punched (Figure 7) through the Accutrac system (Coltene/Whaledent), in laboratory, for later duplication and confection of the veneers in feldspathic ceramics (IPS Empress II, Ivoclar Vivadent) (Figure 8).
case_images: (a) Patient smile at the end of treatment. (b) Intraoral view of cemented parts.
case_images: CRID2018-5368939.009.jpg
case_images: PMC6305029_01_CRID2018-5368939.009.jpg
case_images: fig9
case_images: The excess cement was removed with the aid of scalpel blade number 15c (Solidor) and polished with silicone cups and felt disks (Figure 9).