Single crown on upper front tooth – Challenging case


After removal of crown

Female patient , 40, requests replacement of failed crown on upper front tooth
Existing tooth after removal of crown is considered quite dyschromic. Case is evaluated in regards to shape and colour, therefore additional steps must precede final restoration

Intermediate – Microsurgery & temporarization

Final – Metal-free ceramic crown

In order to enhance tooth proportions and to reduce over-exposure of gums (gummy smile), microsurgery applied. Immediate duplicate of natural tooth fabricated on single acrylic temporary restoration
Final restoration , emax crown by Ivoclar, was fabricated in a manner that fully replicates shape and colour of adjacent tooth
Accident at front tooth – Immediate replacement


Loss of front tooth due to abrupt extraction ( violent incident)

Final extra-oral

Final extra-oral

Immediate prosthetic reconstruction with printed PMMA long-term temporary bridge. This solution provides adequate healing time and better architecture of gum line around prosthetic restoration. Final solution will be implant-born crown at the site of lost tooth
Temporary bridge: a little whiter than adjacent teeth, however with natural semi-translusency that immitates tooth structure
Prosthodontics – Premium interim fixed crowns




Initial Photo

Final photo

Incongruous prostheses coupled with multiple tooth decays and periodontal lesions

Fixed temporary crowns. Full-mouth recovery

Initial photo


Intraoral pic of failed restorations – gingivitis – tooth decays Loss of function – impairment of chewing ability

Intraoral pic of splinted temporary crowns on the upper jaw Dramatic improvement of function – mastication , with ideal tooth contacts

Intermediate Photo

inal photo

Transparent fully customised template loaded with flowable resin and seated firmly on teeth. In 5′ template is removed and resins are hardened and ready to function

Complete aesthetic makeover with premium fixed interim crowns

Prosthodontics vs Orthodontics – Veneers vs Brackets



Male patient, 37 , presented to our clinic requesting a smile makeover. Findings been overlapping/crowded teeth. Patient consulted to follow orthodontic treatment (brackets or Invisalign) but refused.

Diagnosis revealed accentuated aesthetic issues around front upper and front lower teeth. Gingivitis was traced around front lower teeth, hence patient referred to and treated by peer-periodontist. Multi-layer composite veneers was mutually agreed upon to be standalone treatment as opposed to brackets or Invisalign appliances.



Photo taken from the left.

Photo taken from the right.

Note: lateral incisor sticks out in a way too prominent position. In order no drilling to be applied, this very tooth stipulates the outermost/foremost line of the future neighboring prosthetic reconstructions (e.g. veneers).

Note: as opposed to the prominent tooth , central insisors bend inwards and overlap, therefore encompassing one more challenge to be addressed aesthetically restoring width-length ratio of the future veneers.



One-day treatment

Prosthetic alternative – direct veneers ( thin prosthetic shells) applied in layers on the 8 front upper teeth. Highlighted must be, herein depicted reconstruction encompassed NO DRILLING OR TOOTH REDUCE task achieved only by widening upper arch. Composite multi-layering helped thicken veneers by sticking out to the outer-most position as defined by the most prominent tooth.

All, however, in an ‘’unseen’’ fashion.

Direct veneers on 8 upper and 6 lower front teeth. A bright yet natural smile aimed and fairly achieved.

Physiologic anatomy been mimicked to restore ‘’ideal’’ tooth morphology.

Note: Correct rendering of the linear surface grooves as well as the optimum portion of the translucent composites at the ‘’biting’’ edges.



Photo taken from the left

Note: slightly accentuated linear grooves of veneers to mimic physical tooth surfaces.

Note: deployment of ‘’warm-white’’ shades in the middle of veneers helps both add naturality and make thick veneers hardly distinguished (‘’mirage-effect’’ ).

Photo taken from the right

Note: As compared to the initial figure, widening of the new ‘’veneer arch’’ is highlighted, yet in ‘’an unseen fashion’’. New smile design blends in with the lips and the overall appearance. Task accomplished by adding multiple composite layers up to the foremost/outermost position as stipulated by the most prominent tooth.

Patient hardly senses bulkiness though for only few days.

No anesthesia performed – no drilling applied. Dental isolation was implemented to secure moist-free adhesion.
State-of-the-art adhesive system, Optibond FL by Kerr, USA, been deployed.

As documented by numerous cross-linked scientific studies , Optibond FL considered the unbeatable golden standard for strong bonding.

All stages based upon the Aesthetic & Functional analysis. Analysis stands for meticulous diagnostic methodology to peruse data from aesthetics and dental findings. It concludes upon customized treatment planning and upon ideal shape of future restorations.


E-max ceramic crowns


Functional deterioration eg tooth-wear, missing teeth etc resulting in a non-functioning dentition.



Milling of e-max crowns by CNC machines (CAD/CAM workflow) was navigated with aesthetic templates, therefore securing a repeatable and fully customised result.

Bio-aesthetics is a new term to define Biology and Aesthetics. Ideal form and shape of teeth uniquely serve their purpose, therefore Biology and Aesthetics are not regarded two separated entities, rather than one : Bio-Aesthetics.

In-a-day Prosthetic Rehabilitation – Temporary Bridge


Male patient complains about de-cemented bridges, that generated feelings of ”embarrassment and awkwardness” . Being a non-E.U. citizen, he wishes to be treated ”as fast as possible” and to ”have a strong bite again”.

Post op
Post op

Fixed upper PMMA temporary bridge milled in CNC machine and delivered in a day. Systematic workflow comprises multiple stages to consistently produce premium results.

Bright yet natural prosthetic teeth.

Metal-free Porcelain Crowns E-max by Ivoclar Inc


Post op

Functional and aesthetic issues in the anterior section of upper jaw. Abfractures (pieces of teeth popping off) around the cervical areas are correlated to heavily applied bite forces. Patient wishes to have his teeth restored in a ”mostly permanent and reassuring approach”. Thorough examination and analysis concluded upon protection of teeth with ultra-aesthetic metal-free ceramic crowns.

E-max is broadly reputed around the globe, as the best brand for dental ceramic crowns and veneers. Brightness, natural translucency and resilience make up E-max the sole premium solution for high-end outcomes.

Post op

Post op

White aesthetics (porcelain) are finely blended with pink aesthetics (gums) and comprise a pleasant synthesis.

Advanced optical features enrich premium ceramic crowns to mimic natural teeth properties. Lab workflow was launched with the milling of e-max blocks (ingots) (By Ivoclar Inc). E-max ceramic foundations were then stratified with layers of powder ceramic to enhance translucency and aesthetics.

Classic Porcelain-fused-to-metal Crowns looking not so….classic



Female patient from the U.S.A with time limitations and high expectations. She bears failed upper fixed prosthetic restorations.

Intra oral depiction. Launching time of rehabilitation. Failed restorations with deteriorated occlusion and unaccepted aesthetics.



Patient treated with conventional PFM crowns ,yet new generation of methods and materials been used. Metal-free ceramics (e-max or zirconia) excluded from treatment options due to heavy forces being applied (patient is bruxer e.g strong clencher).

Despite conventional prostheses was treatment of choice, workflow was based upon state-of-the-art CAD/CAM procedures. Metal foundation was fabricated with laser sintering and covered with high-end feldspathic porcelain. Please note, that new PFM crowns are not to be considered even similar to PFMs of previous times both in terms of appearance and bio-compatibility.


Intra-oral depiction of PFM prostheses upon session of delivery. Classic looks no longer classic. Note: no greyish margin around gums

Metal-free ceramic crowns e-max

Initial Photo
Final Photo
Multiple issues – tooth decays , failed prosthetic restorations
Metal-free ceramic crowns (e-max by Ivoclar)

Final Photo
Final Photo
Aesthetic improvement with bright yet natural prostheses
Full-mouth recovery combining aesthetics and biologic integration of tissue-friendly ceramics
Complex prosthetic reconstruction on teeth and zirconia implants

Female patient presented with multiple issues: Chewing ability compromised, unpleasant appearance of the upper.

As seen on initial photos, prosthetic restorations were disproportional and appeared greyish at the gum outline.

Notably, lower jaw born bridges supported by failed/decayed teeth.

Full clearance of her prostheses was decided.
Strategic placement of 4 state-of-the-art zirconia implants (Straumann) was carried out at the posterior sites of her lower jaw. Zirconia implants are more neutral than Titanium implants, biology-wise. However, since they are one-piece implants (they contain root & abutment segments joined together), they are more difficult to handle during placement. Hence, as they require exquisite precision, they were placed using precision markers /navigators.

Restorability of upper teeth was evaluated and teeth assessed capable of supporting new prostheses.
After gentle removal of upper prostheses (bridges) , dyschromic incisors and canines were revealed (dark grey). Challenge being grey substrate is difficult to mask and to look natural all at the same time. Launch of her reconstruction was trialing aesthetics and function with two series of transitional/temporary set of crowns.

1- Same day immediate temporaries to help patient leave the practice with same-day teeth
2- State-of-the-art printed PMMA bridges within 2 days to enhance durability and aesthetics
4 Zirconia implants placed on the lower posterior segment.

Definitive restorations were 360 Zirconia veneers/crowns on teeth and Zirconia bridges on Zirconia implants.
On lower front teeth translucent zirconia with medium/small strength (450MP) was utilized to help with aesthetics

On upper teeth opaque zirconia was used to help block out grey substrate. In addition, big zirconia 5-unit bridge had to be fabricated from central incisor to 2nd premolar as patient denied implant placement at missing
canine. That demanded an opaque and strong (1200MP) zirconia block to be cut and used as foundation

Whole reconstruction launched with Aesthetic& Functional analysis i.e. DigitalSmileDesign confirmed by custom-made templates as a trial dentition
Special concern was addressed to build new occlusion at the neutral-most position of the lower jaw. At this centric relation all muscles are tense-free, providing the best chewing ability and ease