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case_images: Series of photographs documenting the initial condition of the patient's maxillary anterior teeth. (a) The extraoral photograph taken during the first appointment highlights the relationship between the maxillary anterior teeth and the patient's lip. This lateral view distinctly reveals the absence of interproximal contact between the lateral incisor and the canine on the right side (elements #10 and #11, respectively), as well as noticeable dental wear, particularly in the cuspal and incisal areas, of the upper incisors and canines. (b) An intraoral photograph, providing a buccal view of the maxillary anterior teeth, clearly shows the existing direct resin composite veneers on the central incisors (elements #8 and #9). Notably, these veneers lack a shiny surface, and there is a visible fracture on the incisal third of the right central incisor (element #9).
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case_images: fig1
case_images: Initial photographs (Figure 1) and bite-wing X-rays were taken for clinical case planning.
case_images: Diagnostic wax-up process conducted on a plaster model encompassing the canine to the contralateral canine (elements #6 to #11) aimed at restoring esthetics and dental anatomy. (a) The facial view of the wax-up model demonstrates the reestablished dental anatomy, providing a clear visualization of the proposed esthetic enhancements to the anterior teeth. (b) The incisal view of the model offers a detailed perspective of the reconstructed incisal areas of the teeth, highlighting the meticulous attention to detail in recreating natural tooth contours. (c) The left-side view of the wax-up model displays the newly designed shapes of the teeth, showcasing the proposed changes from a lateral perspective, which are crucial for achieving a harmonious dental appearance.
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case_images: The length of the maxillary incisors was established based on the patient's dental and facial proportions, and a diagnostic wax-up was performed on stone models of the maxillary canines to the contralateral canines (Figure 2).
case_images: Smile view of mock-up procedure after being adjusted according to interocclusal space, patient's esthetic needs, and clinical evaluation.
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case_images: fig3
case_images: Changes were made to the mock-up, considering the patients' and dentists' esthetic perceptions (Figure 3).
case_images: (a) Tooth preparation of the cervical with a spherical diamond bur at half depth and angled at 45 . (b) Longitudinal grooves in the cervical third were made with half of the active bur. (c) Longitudinal grooves in the middle third were made with half of the active bur. (d, e) Longitudinal grooves in the incisal third were made with half of the active bur. (f) Bur-prepared for half of the vestibular surface. (g) Bur-prepared of the vestibular surface; margins were refined with thin and extrafine diamond burs.
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case_images: It angled at 45  to the tooth-long axis (Figure 4(a)), followed by a round-end taper diamond bur (bur head o = 1.6 mm, bur length 8.0 mm, #2135, KG Sorensen). Longitudinal grooves were created on longitudinal grooves on the buccal enamel with a half diameter of the round-end taper diamond bur, respecting the cervical (Figure 4(b)), middle (Figure 4(c)), and incisal (Figure 4(d)) inclination planes of the buccal surface tooth. The tooth was firstly bur-prepared for half of the buccal surface (Figures 4(e) and 4(f)) and then was extended to the other half of the buccal surface. The gingival and proximal margins were refined with fine and extrafine diamond burs (bur head o = 1.6 mm, bur length 8.0 mm, #2135F, #2135FF, KG Sorensen), extending the tooth preparation to the dynamic visibly proximal areas (Figure 4(g)).
case_images: Step-by-step procedure of the manufacture of the vestibular guide with transparent silicone over the wax-up stone model.
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case_images: Tray Soft and Panasil Initial Contact Light; Kettenbach GmbH & Co, KG, Kettenbach GmBH & Co, Eschenburg, Germany) (Figure 5).
case_images: (a) Resin composite was adapted to the vestibular silicone guide. (b) Resin composite selected was color A3B for the cervical area. (c) The selected color of the composite resin is A1B for the middle third and incisal third. (d) Proximal surfaces were adjusted using the stone model and vestibular silicone guide. (e) Light-curing for 40 seconds on the buccal surface. (f) Light-curing for 40 seconds on the palatal surface.
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case_images: fig6
case_images: Australia), with an output of 1,200 mW/cm2 for 20 seconds (Figure 6(a)). The colors of the resin composites selected were A3B (Filtek Z350 XT, 3M Oral Care) for the cervical third (Figure 6(b)) and A1B (Filtek Z350, 3M Oral Care) for the middle third and incisal third (Figures 6(c) and 6(d)). After light-curing (Figures 6(e) and 6(f)), the semidirect resin composite veneers were taken to the oven for complementary polymerization for 10 minutes in a Heraeus Siloc Oven (Heraeus Kulzer, South Bend, Indiana, USA) at 250 to 370 C. The resin composite veneers of the proximal surfaces were adjusted using fine-grit abrasive discs (Sof-Lex Pop-On, 3M Oral Care), with the aid of the stone model and transparent silicone guide (Figure 6(d)). The semidirect resin composite veneers were finished with a decreasing sequence of Sof-Lex Pop-On discs (3M Oral Care) of medium, fine, and super-fine grits.
case_images: Finishing and polishing steps. (a) Abrasive rubber silicone discs with progressive reduction of abrasive size, starting with discs of medium abrasive size. (b) Fine abrasive size. (c) Superfine abrasive size. (d) Final polishing by the brushes and diamond paste. (e) Final aspect of semidirect resin composite veneers.
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case_images: South Jordan, Utah, USA), starting with the discs of medium, fine, and then super-fine abrasive size (Figures 7(a)-7(c)), followed by the composite polishing wheel brushes (Figures 7(d) and 7(e)). Subsequently, to verify the adaptation of veneers to the dental structure, complete isolation with a rubber dam was performed.
case_images: Marginal adaptation of semidirect resin composite veneers to the tooth preparations. Facial view. Note the presence of gingival inflammation on tooth #10. For this reason, a hemostatic agent with aluminum chloride was used to control bleeding and gingival fluid before cementation.
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case_images: fig8
case_images: The try-in pastes (Variolink Esthetic Try-In, Ivoclar Vivadent, Schaan, Liechtenstein) were used to select the resin cement color (Figure 8).
case_images: The semidirect composite resin veneers after sandblasting with 110 mum aluminum oxide powder. Although not apparent in the image, note that they have been protected with PVS putty material to prevent sandblasting on the external surface. The semidirect composite resin veneer intaglios were prepared as follows: (a) Silane was applied with a small brush to the pretreated surfaces, and the material was allowed to react for 60 seconds. Subsequently, any remaining excess was dispersed with a strong stream of air. (b) The universal adhesive system was applied (AdheSE Universal, Ivoclar Vivadent, Schaan, Liechtenstein). (c) Dual-cure resin cement (Variolink Esthetic DC, Ivoclar Vivadent, Schaan, Liechtenstein) was applied to the internal surface of the semidirect composite resin veneers.
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case_images: fig9
case_images: STD, 3M Oral Care) to avoid sandblasting of the external surface (Figure 9). Sandblasting was performed with 110 mum aluminum oxide powder, under a constant air pressure of 380 kPa, for around 10 to 15 seconds, at a 1.0 cm distance perpendicular from the nozzle to the surface. Plus, Ivoclar Vivadent, Schaan, Liechtenstein) for 60 seconds (Figure 9(a)), followed by a layer adhesive system (AdheSE Universal, Ivoclar Vivadent, Schaan, Liechtenstein) without light-curing in this step, so there is not any risk of a thin layer, already polymerized, to interfere with restoration adaptation and protect the coated surface from light until applying the cement for seating, according to manufacturer instructions for veneers cementation protocol (Figure 9(b)). Phosphoric acid gel (37%) was applied to prepare teeth for 15 seconds with a subsequent rinse-off, and drying, before application of the universal adhesive system (AdheSE Universal, Ivoclar Vivadent). A dual-cure resin cement (Variolink Esthetic DC, Ivoclar Vivadent) was applied to the intaglio of the semidirect resin composite veneers and positioned on the tooth (Figure 9(c)).
case_images: Final outcomes of the restorative treatment using intraoral and extraoral photographs. (a) The intraoral photography captures the semidirect resin composite veneers placed on the central and lateral incisors (teeth #7 to #10) and the direct resin composite restorations on the incisal areas of the canine teeth (teeth #6 and #11). This view highlights the restoration of dental anatomy, interproximal contact, and the shiny surface, effectively rejuvenating the appearance and function of the incisal area between the canine teeth. (b) An extraoral photograph showcases the harmonious integration of the semidirect resin composite veneers with the patient's lip and smile, emphasizing the esthetic success of the treatment. (c) Another extraoral photograph demonstrates the natural appearance of the semidirect resin composite veneers in the context of the patient's overall facial esthetics. Following the cementation of the semidirect resin composite veneers, to protect the esthetic treatment from the effects of sleep bruxism, the patient was provided with an occlusal full mouth guard.
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case_images: fig10
case_images: Finishing & Polishing Strips, GC America Inc., Chicago, USA) on interproximal surfaces. Finally, the resin composite direct restorations were made on the upper canines to reestablish the canine guide (Figure 10).