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Five values of adhesive rehabilitation (part 1)

Recently, we have heard a lot about minimally invasive rehabilitation, and when it comes to front teeth, we sometimes recommend the manufacture of ceramic veneers of minimal thickness.
As before, we must look for ways to preserve as many intact tooth structures as possible at each clinical stage to obtain a balance between function and aesthetics while maintaining the maximum amount of enamel.
Adhesive rehabilitation of anterior teeth is often an additional procedure for a longer and more specialized treatment, such as a comprehensive rehabilitation of the oral cavity or orthodontic treatment.
Maintaining healthy tooth structures and the perfect balance between function and aesthetics are very important points when planning a treatment. Such planning can be performed digitally or in a standard way, but always with an emphasis on the construction of diagnostic wax modeling with its subsequent transfer to the patient’s oral cavity using a restoration model.
This allows the doctor, ceramist and patient to interact correctly. It is important to always involve the patient in the planning process, he can describe his requirements, which will make his understanding of aesthetics and wishes for the final result more clear.
In order to achieve the best result for the patient, it is extremely important to be guided by all our sensitivity, always trying to repeat what nature has created, but with a high level of understanding.
This article is intended to highlight some of the clinical and laboratory steps with an emphasis on details that may be important to the final result.
Initial situation. The patient was referred for aesthetic rehabilitation of the front teeth after orthodontic treatment.

The rehabilitation plan included the manufacture of ceramic veneers on the lateral and central incisors to close the interdental spaces and improve aesthetics.
Initial situation. Pay attention to the old composite restoration, which needs to be replaced before the ceramic restoration.

The old composite restoration has been replaced by a new one (G-aenial, GC).
To improve the predictability of the final aesthetic result, diagnostic waxing must be included in treatment planning.

Wax modeling will make it possible to make a restoration model, will help with the preparation of teeth, the manufacture of temporary restorations, and will also serve as a starting point for communicating with the patient.

It is important to make the wax pattern as precise in shape and texture as possible. In this case, the patient will have the best idea of ​​the final result.

Since there is little disharmony within the gum architecture (especially in the area of ​​the 23 tooth), a surgical splint was made by wax modeling. This will allow during the operation to focus on what was planned for the wax modeling.
The layout of the restoration is made by diagnostic wax modeling. The material used is Protemp 4 A2 bis-acrylic resin (3M ESPE).

The model of restoration made by diagnostic wax modeling.
Landmarks on the layout of the restoration for the preparation of teeth. In this way, the preparation volume can be controlled in accordance with the planned final thickness of the ceramic material.

2 mm preparation from the cutting edges.

The preparation of the teeth is completed. A very conservative treatment of the teeth was carried out, since in this case there was the necessary space for the ceramic material.

Each time, as soon as possible, it should be limited to preparation within the enamel.

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