When the natural dentition exhibits very pronounced shade characteristics, this poses a special challenge for dental technicians. In order to reproduce all the individual nuances of the natural play of colors, veneering ceramic and a wide range of effect materials are required. In addition, reproducing natural vibrancy becomes particularly complicated when the enamel shows a multi-faceted play of color and light, for example in the form of greyishwhite transparency. Here it is necessary to reproduce the individual degree of translucency with different enamel- and effect materials. VITA LUMEX AC (VITA Zahnfabrik, Bad Säckingen, Germany) is a new veneering system that offers virtually unlimited options for precise and reliable reproduction of shade effects and multi-faceted play of light. In the following case report, Dental Technician Michele Prosperino (San Severo, Italy) shows how he successfully handled one of these very sophisticated cases with the new veneering ceramic.
1. Patient case and material selection
A 52-year-old patient suffered fractures on all mandibular front teeth as a result of a trauma. After the teeth were preserved, the patient did not experience any discomfort. The teeth that had been loosened by the trauma had stabilized once again. After a longer temporary restoration phase, the patient now requested a definitive reconstruction. After this restoration, he wanted to be able to smile again as he did before the accident. In order to stabilize the teeth after the traumatic loosening, the dentist and patient decided to use a splinted crown restoration for teeth 32 to 42. When selecting the material, the decision was made in favor of zirconia crown frameworks, which were to be veneered with the new leucite-reinforced, glass-ceramic veneering system VITA LUMEX AC.
2. Shade determination and framework fabrication
The four front teeth were given a local anesthetic. This was followed by systematic and precise tooth shade determination using a VITA shade guide. After the preparation, a mould of the stumps was made, which was used as the basis for the master model. The translucent, pre-shaded zirconia VITA YZ T Color in brightness level LL1 was selected for the framework fabrication. Digitization was carried out using the S600 ARTI laboratory scanner, the framework design was created with the zirconia tooth software and the framework was fabricated using the CAM unit M5 Heavy Metal (all Zirkonzahn, Pustertal, South Tyrol, Italy).
3. Highly precise veneer with shade fidelity
For the washbake, FLUO INTENSE sand and incisal sesame were applied cervically for indepth control of the fluorescence. The basal dentin portion was layered with DENTINE A3, according to the determined basic tooth shade. A 50:50 mixture of DENTINE A 3.5 and DENTINE MODIFIER copper was then applied to the central palatal area. An intensification of the cervical margin was performed laterally with A3.5, in combination with some FLUO INTENSE sand. The central ceramic application of A3 followed with added OPAL TRANSLUCENT opalneutral. Finally, ENAMEL light was added and the first dentin firing was carried out. For the ceramic application, the new veneering ceramic was particularly impressive, due to its outstanding modelling properties, and thanks to its excellent stability. The final enamel layering for the corrective firing was carried out in the upper third of the crown with a 50:50 mixture of ENAMEL medium and clear. After the final firing, the end result showed remarkable shade fidelity. Precise reproduction of the initially determined tooth shade was inc redibly successful using the VITA LUMEX AC veneering ceramic. Finally, fine rotating diamond tools and a glaze firing with VITA AKZENT PLUS GLAZE were used for the finalization.
4. Ideal dynamics of light in the results
The splinted crown restoration was permanently incorporated with a self-adhesive luting composite. The patient was very enthusiastic about the highly esthetic result. The restoration showed an ideal interplay of opacity, chromacity and translucency. The specific shade characteristics of the natural teeth were reproduced precisely, resulting in a reconstruction that integrated harmoniously into the natural dentition. The ceramic could be processed very precisely and showed impressive excellence in shade fidelity, resulting in outstanding light dynamics.