The patient had undergone partial restoration at another clinic two to three years before, but treatment of the mandibular molars, mandibular right second premolar and maxillary left first premolar remained incomplete. The patient’s request was to maintain the restorations already delivered if they were still in good condition.
Treatment
The first step was to increase the vertical dimension of occlusion (VDO) by placing occlusal veneers on the abraded and eroded teeth, especially teeth #17–14, 25–27, 34, 35 and 44. A digital impression was taken with the DEXIS IS 3800W intra-oral scanner (Dental Imaging Technologies Corp.) of the increased VDO with the jaws in centric relation and stabilised with a posterior occlusal jig (Fig. 3).
The restorations were designed on exocad software (Fig. 4), and lithium disilicate was chosen for their fabrication (Fig. 5). The restorations were bonded adhesively in the patient’s mouth. After the increasing of the VDO, the patient’s anterior occlusion was ideal for restoration of anterior guidance. It was therefore necessary to provide the patient with orthodontic treatment (Fig. 6). After the orthodontic treatment had been completed, the incisal edges of the mandibular incisors were restored directly with composite (Fig. 7).
Subsequently, the final aesthetic wax-up of the anterior sextant was completed in order to ultimately validate the aesthetic restoration and to guide the minimally invasive preparation of the maxillary crowns (Fig. 8). The final preparation was guided by the mock-up (Fig. 9) and, for the most part, was limited to the interproximal areas (Fig. 10). After that, we took a final digital impression of the anterior crowns after displacement of the gingiva with retraction cord (Fig. 11).
For the digital design, limited reduction of the inferior half of the buccal surface of the monolithic restorations was performed in order to allow stratification of porcelain for achieving the best possible aesthetic result (Figs. 12 & 13).
Ultimately, the final restorations (Fig. 14) were bonded adhesively in the mouth under dental dam isolation (Fig. 15). The patient was followed up several weeks after the cementation (Figs. 16 & 17).
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