Minimally invasive restoration of an incisal edge defect
Sheng Fang and Feng Li present a case study illustrating how they restored an incisal edge defect with a minimally invasive process on the central maxillary anterior tooth using a hybrid ceramic.
A 21-year-old patient visited the dentist’s practice. The composite filling of her distal corner of tooth UL1 was fractured due to secondary caries.
She wanted a long-term, permanent restoration to be integrated harmoniously into her tooth structure.
This restoration was scheduled to be minimally invasive and required a reconstruction with thin walls. The dentist and dental care team opted for a CAD/CAM-supported reconstruction using the hybrid ceramic Vita Enamic.
Tooth shade determination and material selection
Precise colour information is essential in making the correct choice when it comes to the shade-matching material.
To ensure optimal shade integration of the existing incisal edge defect on the reconstruction, the tooth shade was determined using the Vita Linearguide 3D-Master shade guide, after applying local anaesthesia.
Systematic tooth shade determination was carried out in two steps. In the first step, a brightness level from zero to five was determined using the Vita Valueguide 3D-Master shade guide.
The colour intensity and shade were then determined using the appropriate shade guide from the Vita Chroma/Hueguide 3D-Master. This resulted in the selection of tooth shade 1M2.
This primarily involved a restoration of the translucent enamel area. A translucent HT blank in the colour 1M2 was selected for the CAD/CAM-supported fabrication.
To prepare for the digital impression, only the caries was removed and the enamel edges of the defect were slightly tapered.
CAD/CAM fabrication and finishing
This was followed by the intraoral scan with the CEREC Omnicam 4.2 and the virtual design of the restoration using the CAD software Inlab CAD 15.2.
The order was sent to the Inlab MC XL milling unit and executed there (all Dentsply Sirona). Afterwards, the sprue was removed and the restoration was finished with fine diamond instruments. Lastly, the final finishing was done using the Vita Enamic Polishing Set technical.
During the try-in, the partial restoration was a perfect fit and could be etched on the adhesive surfaces using hydrofluoric acid and then silanised.
The tooth substance was pre-treated using the acid etching technique and then an adhesive was applied. This was followed by final seating using composite cement.
Finalisation and summary
After the cement residues were removed, the transitions between tooth and restoration were evened out using the Vita Enamic Polishing Set.
The delicate restoration showed a very harmonious integration in the natural tooth structure. This is thanks to its natural play of colours and light.
Due to the comparatively low brittleness of hybrid ceramic – even with very thin wall thicknesses – and its thinly tapered edges, hybrid ceramic can be precisely processed and the patient provided with minimally invasive treatment.
Using the digital workflow to create an efficient fabrication of the indirect restoration made it possible to treat the patient in one session.
The dental team and the patient were completely satisfied with the results of the final restoration.
The worldwide CAD/CAM hybrid ceramic Vita Enamic consists of a porous pre-sintered fine structure feldspar ceramic matrix that is infiltrated with polymer. The dual ceramic-polymer network allows for very delicate reconstructions with wafer-thin, precise marginal areas of up to 0.2mm. The CAD/CAM material exhibits excellent functional and aesthetic integration into the natural tooth structure. This is thanks to its dentine-like elasticity, its enamel-like abrasion behaviour and its natural light transmission.
This article was first commissioned for Dentistry magazine. Read the latest issue of Dentistry magazine here.