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The Clinical Case
VENEERS

HEALTHY WHITE TEETH WITHOUT SURGERY

Clinical:

INITIAL SITUATION

A 58-year-old male patient presents with irregularities in the shape, color, and position of the front teeth. Orthodontic treatment could be a valid solution for aligning the teeth, but it would not address the aesthetic issues of color and shape.

The patient also presents with small mixed gingival recessions combined with dental abrasions. He refuses any surgical treatments or any procedure that would take a long time, such as orthodontics.


Figure 1: Digital Smile Design – Planning the New Smile

OBJECTIVE

Enhance the smile overall, achieving total harmony between the teeth, gums, and labial frame.

We start by taking photos and videos of the current situation and the expected result.

Next, together with the dental technician, we create a mock-up to simulate the new smile.

Once the final result is shared and approved, a final impression is taken either traditionally (with paste) or digitally (with a 3D scanner) for the fabrication of custom, biocompatible veneers.


Figure 2: Resin Simulation (MOCK-UP), Finished and Polished

TREATMENT

The tooth preparation is done using calibrated burs with controlled thickness to ensure customized treatment for each patient, prioritizing the maximum preservation of dental tissue. It is important to note that being too conservative is not always the correct approach; each tooth requires a specific preparation, tailored to the initial models to ensure the long-term durability and aesthetic result of the treatment.

We should not worry if the teeth are shaped by a few tenths of a millimeter more or less, as once the veneers are cemented, the underlying tooth will be bonded to the ceramic, and will never be visible again.

What truly matters is relying on competent professionals who understand the material and know exactly when and where a tooth should be shaped to achieve the best in terms of functionality and aesthetics in the final outcome.


Figure 3: Calibrated Preparations – Measuring Thickness with Millimeter Burs


TREATMENT PHASES

After placing the resin mock-up and obtaining the patient’s approval, we proceed with dental preparation guided by calibrated burs to achieve customized and minimally invasive tooth preparations. This phase does not require anesthesia, ensuring a more comfortable experience for the patient while achieving optimal results.


Figure 4: Calibrated Preparations on the Resin Mock-up


Figure 5: Final Minimally Invasive Preparations (0.5mm)


After the tooth preparations, the impression is taken either with traditional materials (silicone) or using a digital scanner.


The dental technician then creates the ceramic veneers, carefully checking the thickness of each veneer to ensure the optimal fit and aesthetic result.


Figure 7: Controlled Thickness Veneers



The veneers are cemented one by one using adhesive materials, without the need for anesthesia, ensuring a precise and secure fit.


TREATMENT TIMELINE

The treatment typically consists of 2 to 3 sessions:

1. Aesthetic Simulation:

This session includes tooth preparation and taking the impression. The duration of this session can vary from 1 to 4 hours, depending on how many teeth require veneers.

2. Veneer Try-In (and Possible Cementation):

The veneers are tried in to check for aesthetic satisfaction and optimal precision. The duration of this session can vary from 1 to 4 hours, depending on the number of teeth being treated.

3. Cementation of Veneers and Control Radiographs:

After cementing the veneers, control radiographs are taken to ensure no subgingival cement residues remain, which could lead to inflammation over time.


Figure 8: Veneer Cementation


Figure 9: Final Intraoral Aesthetic Result


Figure 10: Final Intraoral Result


Figure 12: Night Guard


MEDICAL CONSIDERATIONS

Veneers should not be considered merely an aesthetic treatment; they are also a minimally invasive and long-lasting prosthetic rehabilitation. Every step of the procedure must be carried out with the utmost attention to detail.

The final aesthetics must be customized for each patient, taking into account both the shape and color of the veneers.

Final radiographs are essential to verify:

• Correct cementation of the veneers.

• Even distribution of the cement underneath the veneers, without creating air bubbles, which could lead to carious infiltration or fractures over time.

Radiographically, any subgingival cement residues can be identified, as they can cause gingival inflammation and bone loss over time if left untreated.



Figure 13: Control Radiographs After Veneer Cementation



Figure 11: Final Extraoral Result – Dentolabial Integration

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