Illuminating the Possibilities

A 55-year-old female patient initially presented to one of my clients, a prosthodontist, with the desire to enhance her smile by making it brighter and more symmetrical, more youthful. She was also concerned with a slight lisp. Unsurprisingly, she was also insistent that it blend in with the rest of her natural dentition.

The decision was made to fabricate a diagnostic wax-up, stone duplicates, putty matrix of the wax-up, and finally, a clear suck-down with depth-gauge access holes for reduction. After approval of the temporaries, the six restorations were ready to be fabricated in lithium disilicate and facially layered with VITA LUMEX^® AC veneering porcelain. Together with my client, we chose this combination of materials for optimal results. Lithium disilicate was utilized to block out any underlying stump shades. VITA LUMEX AC veneering material was selected for its shade stability, esthetics, and ease of use.

Complete communication from diagnosis to treatment planning is, and will always be, the key to successful results in the cases that we deliver. The pre-operative evaluation, models, photography, bites, and mounting are all critical steps to ensure success. Today, most of my clients are out of state, so I rely on file-sharing technologies to coordinate communication.

The tooth preparation was simplified utilizing the reduction guides provided with the diagnostic wax-up. In this case, we prepared for full crowns. As stated earlier, the clinician and I decided to utilize monolithic lithium disilicate with facial cutbacks.

A stone copy of the diagnostic wax-up was scanned into the CAD program as an in situ model to design an exact copy in the restorations. The virtual crowns were cut back facially to allow for esthetic veneering porcelain, and milled using a wet mill. The restorations were then crystallized and fit to the model.

At this point, the restorations were enhanced with VITA AKZENT^® Plus Chroma Stains in 3D-Master to create a polychromatic look by increasing chroma and value saturation without increasing overall size. Once the polychromatic look was achieved with the stains, the crowns were facially layered with VITA LUMEX^® AC porcelain. This process began with applying a thin layer of Chroma Intense (Ivory) for opacity. Next, Opaque Dentine, Dentine, and Enamels were utilized in the first bake. Translucents (Deep Blue, Foggy Grey, and Smokey White) were used as well to enhance incisal edge characterization. A second bake was applied with a mixture of Opal Translucents, Pearls, and Cervical Enamels. Once the crowns were ready for stain and glaze, I used the VITA AKZENT^® Plus Stain and Glaze kit.

The patient was pleased with her bright, new, youthful smile that blended harmoniously with her natural dentition. Also, due to proper design, her phonetics were improved and her slight lisp was eliminated. The VITA LUMEX AC porcelain and VITA AKZENT stains and glazes made all the difference.

Key Takeaways

› Complete communication from diagnosis to treatment planning is important for successful results
› The pre-operative evaluation, models, photography, bites, and mounting are all critical steps
› Listening to the patient's needs and being able to accommodate their desires is critical
› Utilizing the right materials for the right situation is important
› Partnerships are the key to clinician/technician relationships

Disclaimer: The statements and opinions contained in the preceding material are not of the editors, publisher, or the Editorial Board of Inside Dental Technology.

About the Author

Bobby Williams, CDT
Owner and Operator
Synergy Ceramics
Plano, TX

Company Information
VITA North America
vitanorthamerica.com
800-828-3839