A 23 years old Turkish female patient referred to Süleyman Demirel University Faculty of Dentistry Department of Prosthodontics complaining about the disharmony in maxillary incisors, and canines. The patient's medical and dental histories were unremarkable. Her oral hygiene performance was satisfactory and flossing was also applied by the patient. Clinical examination revealed the presence of an irregular maxillary incisors and canines (Figure 1). The maxillary dental arch presented two lateral incisors half behind the centrals, rotationally and palatally positioned in the dental arch (Figure 2). Orthodontic therapy was recommended but the patient expressed that she had already experienced several visits in orthodontics clinic but none of the visits helped to persuade her accepting orthodontic therapy.
Restoration of the anterior maxillae utilizing ceramic laminate veneers was decided. Prior to preparation with the composite mock-up technique the esthetic appearance of the patient is predicted. Palatal tooth surfaces and facial gingiva have been isolated with Vaseline (Rosense, Turkey); the facial enamel is spot etched with 37% phosphoric acid etch-gel (Alpha-Etch 37, Dental Technologies, USA) for a few seconds, then rinsed and dried to secure the retention of the future mockup. The incisal part and facial sides of incisors and canines were loaded with A1 shade composite resin material incrementally. Restorative composite is polymerized with LED light curing unit (Freelight Elipar, 3M-ESPE, Germany) for 40 sec. The mock-up is finished and polished with a set of aluminum embedded abrasive discs (Sof-Lex Discs, 3M-ESPE, Germany). The assessment at 2 weeks reveals a harmony between the incisal edge positions and the lower lip. The shape and position of the teeth is discussed and approved by the patient (Figure 3).
During preparation, the facial and palatal surfaces were reduced to 0.5-1.0 mm and the incisal reduction was 1.5 mm. All the incisors and canines were prepared with a chamfered finishing line with rounded internal line angles. The cervical preparation ended at the cemento-enamel junction. Smooth margins were created to prevent stress concentration zones (Figure 4). Once the preparation was completed, impressions were made using polyvinylsiloxane impression material (Elite H-D, Zhermack, Germany). The veneers were waxed up to dies and they were fabricated from lithium disilicate-reinforced glass ceramic material, IPS Empress 2, using the heat press technique according to the manufacturer's recommendations. After divestment, the veneers were finished and glazed (Figure 5).
The inner surface of ceramic veneers were treated with air-particle abrasion using 50 μm Al2O3 (Korox, Bego, Germany) with a chairside air-abrasion device (CoJet, 3M-ESPE,Germany) from a distance of 10 mm at a pressure of 250 kPa bar for 10 s. Then each surface treatment was followed by acid etching with 9% hydrofluoric acid (Pulpdent Corporation, USA) prior to silanization. A silane coupling agent (Pulpdent Corporation, USA) was applied to the internal veneer surface for 60 s and air-dried.
During the cementation process each abutment tooth was etched for 15 s using a 37% phosphoric acid etch-gel (Alpha-Etch 37, Dental Technologies, USA). Subsequently, the tooth surface was rinsed thoroughly and air-dried gently. Dentin primer and adhesive were applied according to the manufacturers' instructions (Clearfil, Kuraray). Following the bonding application a thin layer of light polymerizing composite resin luting cement was applied at the intaglio surface of the veneers, placed onto the prepared teeth and light-polymerized for 40 s (Elipar Free Light, 3M ESPE) from palatal, buccal and incisal sides.
Excess luting cement was removed and the marginal area was finished and polished with abrasive discs and strips. Restorations were checked to avoid any occlusal interference (Figure 6). The patient was satisfied with her new smile line and excellent view of the anterior teeth (Figure 7) and was recalled in 2 days and encouraged for better dental flossing and also recalled every 6 months for periodical controls. No complication was observed during 3 years clinic service.
