CHIEF COMPLAINT:
Patient expressed the desire to “have teeth of matching size, with unnoticeable restorations”.
DIAGNOSIS:
Male patient, 38 years old, non-smoker. Had both upper central incisors with extensive resin restorations. Tooth 1.2 had undergone a class IV resin restoration. Tooth 1.1 had resin coating over its entire coronary surface. Tooth 2.1 had a class III restoration. Middle teeth had noticeable asymmetry in morphology and size. Teeth were vital. Patient had good gingival health and good dental hygiene.
TREATMENT PLAN:
A feldspathic ceramic full crown was proposed for tooth 1.1. A "No Prep" feldspathic ceramic veneer was proposed for tooth 2.1. After having suffered physical trauma due to an accident, the patient was suggested a vertical insertion feldspathic ceramic veneer for tooth 2.1.
TREATMENT NOTES:
Tooth 1.1 was prepared for a feldspathic ceramic full crown. Preparation consisted of composite resin removal and a chamfered finish line. Almost no preparation was necessary for tooth 2.1, with only some roughness being created on the labial surface and mesial inter-proximal. After tooth preparation, a print was made using wash impression technique, originating a Geller type working model. The crown and veneer were prepared and bonded in-mouth. Bonding started with the crown, using relative isolation. After bonding of the crown, a rubber dam was placed for veneer bonding.
Two years later, the patient suffered a trauma which fractured the veneer on tooth 2.1. To address this situation, dental preparation was performed on tooth 2.1 for placement of a vertical insertion feldspathic ceramic veneer. A silicon index was previously prepared to guide the making of this new veneer, which was bonded in mouth after absolute isolation. Despite the trauma, the patient was able to have his problem solved within minimally invasive solutions.