Challenge has been his young age along with preservation of healthy tissues.
Advanced hybrid veneers without preparation/drilling has been treatment of choice
In one appointment, new aesthetics and occlusion were analyzed and designed.
In the next appointment, Enamic veneers were bonded to intact teeth using state-of-the-art cleaning and bonding protocol.
Finishing and polishing were performed in the very last appointment.
Entire process lasted 10 days, in only 3 appointments.
No tooth preparation or anesthesia was required.
Due to clenching and grinding, her teeth had significantly abraded and shortened, causing serious aesthetic problems.
Patient requested to improve the appearance of her mouth.
Case was assessed as high-risk and of high-demands as there was peril of porcelain fractures and potential issues with the temporomandibular joints.
Careful raise of vertical dimension was initially performed using bonded resins (mock-up) to help gain prosthetic space without drilling teeth.
At second phase long-term temporary restorations replaced bonded mock up.
Partial coverage restorations as well as full coverage veneers were chosen as treatment plan dictated.
Teeth were not drilled and state-of-the-art porcelain restorations were bonded using a strict protocol (use of dental isolation).
Monolithic emax restorations were used with micro-layering to provide both strength and aesthetics.
Shade was Bleach1
Aesthetic evaluation confirmed patient’s remarks. Functional assessment showed a difficult class II occlusion i.e. lower teeth located far back and inward as compared to the position of the upper. Such occlusion scheme regularly calls for a preliminary orthodontic treatment as a start off phase. However as stated by patient, she had already had been treated with brackets all to no avail. Therefore a second ortho treatment was denied
Moreover extended tooth wear made the restorative treatment even more difficult to handle and to safely design with a new occlusal scheme. Tooth-wear patients are regarded high-risk in terms of sustaining restorations free of chipping or catastrophic fractures
Due to her limited stay in Athens, we decided to proceed to complete aesthetic and functional analysis and to bond the simulated new dentition on her native teeth with composites. Hardly any teeth showed at smile. Aesthetic assessment showed a need for 2.00 mm elongation of the upper. However that would be considered an easy-to-break restoration due to the unfavourable occlusal scheme.
A limited raise of the vertical dimension of occlusion (VDO) was decided however not to the ideal assumed height, because of the exaggerated class II occlusion.
A thickening of the upper teeth was ,too, decided to hold up the upper lip thus to help show more tooth volume
An increase of the lower front teeth was not an option because they , too, showed too much
An increase of the height of the lower posterior was designed to somehow help gain prosthetic space for the upper front
Porcelain 360 veneers in the front and porcelain onlays on the posterior are planned as definitive restorations
Transparent templates were fabricated from the models of the intended new dentition. Being the ‘‘negative” replicates of the intended upper and lower teeth, they were filled up with flowable composites and seated on each jaw. Light cure was followed to help bond and to harden the composites therefore new dentition was a acquired in 5′ on adequately primed teeth without any drill or cut at all
Tooth contacts were adjusted and bonded prototypes will now serve their versatile role for the next months as the perfect trial dentition
