case study _ veneers I Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 The case was documented according to the European Society for Cosmetic Dentistry (ESCD) guidelines as a requirement for obtaining certification as a specialist in Cosmetic Dentistry ESCD (these guidelines are available from the author upon request). An integral part of documentation is the use of identical camera settings for all photographs that have to be taken before and after any reconstruction. In addition to the correction of the damage, the following were especially important to the patient: longevity of the reconstruction, ability to select shape and colour of the veneers, use of all-ceramics, minimally invasive preparation, and harmonious aesthetics. Furthermore, the patient desired a purely cosmetic optimisation of the lower central incisors with slight contouring and, if needed, BRITESMILE bleaching after the application of the upper veneers. First, an aesthetic functional wax-up of the six upper teeth was created in order to facilitate optimal communication between patient, dentist and dental technician throughout each stage of the veneer preparation. The patient’s history revealed that four premolars had been extracted in his youth, followed by orthodontic therapy. Over the years, all teeth had been treated conservatively and the wisdom teeth were well adjusted. All upper and lower premolars and molars had been treated with allceramic zirconia crowns. The patient did not desire a complete makeover with overbite reduction. Therefore, we focused on the design of perfect and fracture-free veneers for the mandibular central incisors. Thus, all interfering factors had to be minimised. The aesthetic contouring of the lower central incisors naturally leads to a harmonious overall appearance. In addition, one of the main causes of veneer fracturing can be eliminated: patients with extreme mandibular mobility are able to shift into extreme areas of protrusion and latero-trusion, often going much beyond the cutting edge of the maxilla. However, fracturing and failure of a veneer are not merely caused by forward movement. Problems often occur during the backwards movement of the mandible when the teeth slide back into retrusion and become stuck and, owing to the extreme forces, a veneer fracture can result. These extreme retrusions can be imitated in the articulator only if the technician registers a bite situation of this position. If the technician only considers standard mandible movements, he will not be able to reach the extreme areas of the existing habitual dysfunction. Fig. 4_Preparation without gingival correction. Fig. 5_Crown elongation. Fig. 6_Preparation. Fig. 7_Final preparation. Fig. 8_Sulcus demonstration with diode laser. Fig. 9_Functional temporaries according to wax-up. Patient-oriented articulation adjustments Reference® SL SKN R INSERT R ANGLE L INSERT L ANGLE SEQUENTIAL INSERT 3 MM BLUE 51 BLACK 41 5 MM BLUE 53 BLACK 47 10 MM BLUE BLUE TKN R INSERT R ANGLE L INSERT L ANGLE 3 MM WHITE 6 WHITE 12 5 MM WHITE 6 WHITE 8 10 MM WHITE 6 WHITE 5 PROTRUSIVE ORANGE LATERAL RIGHT ORANGE LATERAL LEFT ORANGE STANDARD DISTANCE 200 MM, CALCULATED AT 110 MM CADIAX® COMPACT 2.46 COPYRIGHT© 1999–2005 GAMMA GMBH. KLOSTERNEUBURG, AUSTRIA, HTTP://WWW.GAMMADENTAL.COM LICENCE: 1736DCCPS cosmetic dentistry 4 _ 2009 I 15