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Inside Dental Technology

April 2012, Volume 3, Issue 4
Published by AEGIS Communications


Ceramic Restoration Using VITA VM®9 Ceramics

Efficient manual layering with this material can produce lifelike tooth characteristics and outstanding esthetics.

By Klaus Göbel, MDT

In the featured case, a 58-year-old man presented with unattractive upper anteriors and tooth mobility that prevented him from biting at will. The patient requested regular, harmonious anterior tooth positioning with slightly lighter restorations that harmonized with his residual dentition. A red wine merchant by profession, the patient desired attractive upper anterior esthetics, because the mouth often comes into focus during wine-tasting sessions when determining whether the wine is pleasing to the palate. The goal of the case was to use the fine-structure ceramic VITA VM®9 (Vident, www.vident.com) and efficient layering to complete an anterior restoration with lifelike characteristics.

Treatment Planning and Preparation

The dentist diagnosed endodontically treated and compromised teeth in the anterior area with first- and second-degree tooth mobility, as well as several enamel tearouts and small discolored fillings in the visible anterior area. Teeth Nos. 8 through 10 all required treatment. The adjacent teeth—particularly the lateral incisor No. 7 and the lower anteriors—were not treatment planned at that time. The restorative treatment required splinting the teeth. A three-unit supportive structure was planned for teeth Nos. 8 through 10, accordingly. Because of its gingival-friendly properties, the dentist proposed using zirconium dioxide. The patient expressed the desire to have his teeth professionally cleaned subsequent to all treatment measures to remove extrinsic discolorations and hard plaque.

Teeth Preparation

The dentist prepared the teeth (Figure 1) and discharged the patient with a provisional restoration fabricated in the dental practice. During the next treatment session, the dentist determined the basic shade of the teeth (Figure 2) before the laboratory-manufactured temporary restoration was seated. To ensure a reliable result, the VITA Easyshade Compact was used to measure the shade digitally (Figure 3). The shade was determined to be 5M1.

With the aid of the prefabricated VITA shade tabs, the additional materials for characterization were selected (Figure 4 and Figure 5). A layering diagram was then created for the
ceramics (Figure 6).

Veneering

After the wash opaque firing, the required fluorescent effect liner was applied to the anatomically designed substructure to create specific effects in the underlying shade. The dentin core was subsequently built up using base dentin in the shade 5M1. Light-yellow effect chroma (EC3) was added to characterize the cervical third. This modifier material can also be applied in its pure state directly to the cervical margin or can be used for incorporating vertical shade effects up to the incisal edge. The incisal third is layered alternately with base dentin and greyish translucent effect enamel EE11. This creates a lifelike effect and ensures harmony between the veneer restoration and the surrounding natural dentition (Figure 7).

Conclusion

The restoration produced a highly esthetic appearance with quality, intricate shade effects (Figure 8 and Figure 9). Investing the time at the beginning of treatment in the functional analysis, as well as making the determination of the tooth shade and shape, achieved the desired effect in an efficient manner.

The VM9 ceramics feature good stability characteristics as well as excellent dimensional stability. This ceramic exhibits a dense and homogeneous surface—its light refraction and reflection properties correspond to natural tooth enamel. Corresponding particles have been incorporated into the ceramics for natural opalescence and fluorescence. The firing properties—which included firing stability and a low degree of shrinkage—were impressive. The veneer was also easy to polish with good results. Using the VITA VM 9 material, with its 26 dentin shades in the VITA 3D-Master® system, produced the desired effect that both the dentist and patient were seeking.

Klaus Göbel, MDT, is the owner of Dental-Labor Klaus Göbel in Bonn, Germany.

Acknowledgment

The author would like to thank Dr. Bettina Griese as well as the entire laboratory team.

Disclaimer

The preceding material was provided by the manufacturer. The statements and opinions contained therein are solely those of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dental Technology.

For more information, contact:
Vident, A VITA Company
Phone 800-828-3839
Web www.vident.com
E-mail info@vident.com


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Image Gallery

Figure 1  The prosthetic situation before treatment showing the prepared teeth. The previously unattractive appearance was caused by dark discoloration of teeth after endodontic treatment. In addition, there were colored fillings in the anterior area

Figure 1

Figure 2  The patient with the laboratory-fabricated provisionals on teeth Nos. 8 through 10 in order to verify the tooth shape, the incisal contour, and the color.

Figure 2

Figure 3  Determining the correct tooth shade—5M1—with Easyshade Compact.

Figure 3

Figure 4  Preparation for the ceramic layering. The effect chroma ceramic, which is to be mixed with the dentin particularly in the cervical third, is determined using the shade tabs.

Figure 4

Figure 5  Preparation for ceramic layering. The incisal shade for the transparent incisal area is determined.

Figure 5

Figure 6  Layering diagram for the ceramic layering.

Figure 6

Figure 7  The result after the definitive seating. Appropriate characterizations were added to obtain a harmonious shade match with the adjacent natural teeth and the antagonists. Professional tooth cleaning was planned for a later time.

Figure 7

Figure 8  View from the patient’s right-hand side.

Figure 8

Figure 9  View from the patient’s left-hand side.

Figure 9