Manrina Rhode presents a case in which she helps a patient achieve a larger, whiter, more aesthetic smile using 20 IPS Emax lithium disilicate glass-ceramic veneers
A 32-year-old patient presented at DRMR in 2020. He wanted a makeover that would give him larger, brighter, whiter teeth and a more perfect-looking, ‘Hollywood’ smile (Figure 1). A full examination was carried out and photographs and X-rays were taken.
The patient had a healthy mouth, teeth and gums with one small filling on his UL6 and a chip on the LR1 (Figure 2).
Composite versus porcelain veneers
Porcelain veneers can deliver a highly aesthetic and durable outcome using minimally invasive preparation techniques. Composite resin will typically last for around five years, whereas I would expect porcelain restorations to have a lifespan of 20 years, if properly looked after.
The patient’s aesthetic concerns could be addressed by placing 20 Ivoclar IPS Emax Press veneers. I have been using IPS Emax veneers for 22 years and have provided more than 14,000 ceramics. Emax materials have never let me down.
A stick bite, conventional impressions and a full series of photographs were taken along with periapical X-rays. A wax-up was fabricated.
Minimally invasive veneers preparation
A temporary stent was made to replicate the shape and length of the wax-up and to outline the incisal edges. The Galip Gürel technique (Gürel, 2007) was used to ensure the teeth were only prepared where necessary.
The incisal guide was used to check clearance on every tooth for placement of a 0.3mm IPS Emax veneer. The dentition was tidied up, supragingival and chamfer margins created, and contacts checked.
Tooth shade and temporary veneers
Photographs were taken of the prepared teeth and base shades (Figure 3). The Ivoclar Ivobase Shade Guide was used to communicate the tooth shade to Precision Dental Studio.
An analogue impression was taken using Ivoclar Virtual putty. The vinyl polysiloxane impression material provides exceptional readability and precision. A bite registration of the upper and lower prepared teeth was recorded.
Ivoclar Optragate latex-free lip and cheek retractor was placed for an accessible, manageable treatment field. The teeth were spot-etched and bonded, rinsed and dried. Luxatemp shade B1 was selected for the temporary veneers (Figure 4).
Permanent pressed ceramic veneers
Two weeks later, the patient returned to have permanent IPS Emax veneers placed. Shade BL2 had been selected using the Ivoclar A-D shade guide with Bleach Shades (Figure 5).
The temporary material was removed and the teeth cleaned. The IPS Emax ceramic veneers were dipped in water, tried in the mouth and shown to the patient.
Each veneer was etched with hydrofluoric acid, washed and Ivoclar Monobond Plus applied to the inner surface. The enamel and dentine were etched using 37% phosphoric acid and a primer and bond applied.
Reliable, predictable dental bond
Ivoclar Variolink Esthetic neutral shade was used for the adhesive cementation of the restorations. The material’s consistency makes it easy to use with a reliable, predictable bond.
The veneers were positioned and spot-cured. Residual cement was removed and the veneers cleaned and flossed. The restorations were light-cured and finished with a long yellow diamond bur and a rugby-shaped yellow diamond bur.
The teeth were cleaned interdentally and the bite checked. An alginate impression was taken for fabrication of a night guard to protect the new restorations.
Veneers with superior aesthetics and function
With minimally invasive preparation, we provided the patient with custom-made, superior aesthetics and long-term function. The patient was delighted with his smile transformation (Figure 6).
Reference
Gürel G (2007) Porcelain laminate veneers: minimal tooth preparation by design. Dent Clin North Am 51(2): 419-31
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