Near-Natural, Highly Individual Shade and Light Play

In this case, the challenge was to reproduce all the nuances and distinct individual characteristics of the natural neighboring teeth. The single anterior crown needed to fit harmoniously into the esthetic zone at the posterior. To achieve this, the distinctive tooth characteristics had to be reproduced with VITA VM 9 veneering porcelain and VITA AKZENT Plus stains (VITA Zahnfabrik, Bad Säckingen, Germany). Below, Dental Technician Renato Carretti and Dentist Dr. Denis Schafroth explain their process for treating the patient. The highly individual shade characterization is described in detail.

1. Initial situation
A senior arrived with a fractured composite filling on tooth 11. The practitioner and patient decided on long-term stabilization for the tooth with a full ceramic crown. The natural teeth displayed a varied play of shades, with whitish fluorosis and brownish discolorations. The patient found it ­important for the new reconstruction to achieve a natural appearance. For veneering the planned zirconia substructure, they opted for the highly nuanced VITA VM 9 veneering porcelain together with the VITA AKZENT Plus stains. In the first ­session, the tooth was prepared, scanned and provisionally restored. The base tooth shade D3 was identified.

2. Highly individual veneering
The crown substructure was fabricated of CAD/CAM-supported super-translucent zirconia in order to simulate the light effects of the neighboring teeth as closely as possible. The patient-specific veneering was achieved using a variety of VITA VM 9 dentine and effect materials. After the first dentine firing, a visual inspection took place. Afterwards, the crown was characterized in several steps and the intermediate firing results were checked directly in the patient's mouth.

3. Natural characterization
In the neck area, yellowish shade saturation was achieved using VITA AKZENT Plus CHROMA STAINS B. In addition, VITA AKZENT Plus EFFECT STAINS 05 (orange) and 06 (rust red) were also characterized here. Fluorosis was increased ­incisally and a subtle effect was added in the upper cervical third using cream-colored ES02. "I added warm tones to the middle crown area with CHROMA STAINS A. The stains are intense and clearly visible in both the application of the color and the end results," explained Carretti. CHROMA STAINS B ultimately provided more chromaticity in the interdental area. The characterizations were gradually coupled by multiple fixation firings. The status of the optical integration was visually compared on the patient.

4. Vibrant 3D shade effect
In order to give the shades an effect from the inside, the central area was coated with the transparent WINDOW and the incisal area was coated with alternating layers of EE9 (bluish translucent) and EE11 (greyish translucent). ­Carretti was very satisfied with the results after working with a fine diamond and fine-grained sandpaper: "To complete the reconstruction, I only really had to do the glaze firing with the glazing material finishing agent and then polish it with pumice manually!" The multi-facetted restoration integrated itself harmoniously into the esthetic zone. The demanding patient was very satisfied with the highly esthetic result.

Report 11/18

<p>"VITA VM 9 veneering ceramic and VITA AKZENT Plus stains enable highly individual restorations with a natural appearance."</p>

"VITA VM 9 veneering ceramic and VITA AKZENT Plus stains enable highly individual restorations with a natural appearance."

DT Renato Carretti, Zürich, Switzerland and Dr. Denis Schafroth, Dietikon, Switzerland

Fig. 1: Initial situation: In order to stabilize tooth 11 long-term, it was prepared for a full ceramic crown.
Fig. 1: Initial situation: In order to stabilize tooth 11 long-term, it was prepared for a full ceramic crown.

Fig. 1: Initial situation: In order to stabilize tooth 11 long-term, it was prepared for a full ceramic crown.

Fig. 2: The base tooth shade was determined using the VITA classical A1-D4 shade guide.
Fig. 2: The base tooth shade was determined using the VITA classical A1-D4 shade guide.

Fig. 2: The base tooth shade was determined using the VITA classical A1-D4 shade guide.

Fig. 3: The results after the first dentine firing in the clinical try-in.
Fig. 3: The results after the first dentine firing in the clinical try-in.

Fig. 3: The results after the first dentine firing in the clinical try-in.

Fig. 4: The VITA AKZENT Plus stains were applied in several steps and repeatedly fixed with a firing.
Fig. 4: The VITA AKZENT Plus stains were applied in several steps and repeatedly fixed with a firing.

Fig. 4: The VITA AKZENT Plus stains were applied in several steps and repeatedly fixed with a firing.

Fig. 5: The characterized and prepared crown during the clinical try-in.
Fig. 5: The characterized and prepared crown during the clinical try-in.

Fig. 5: The characterized and prepared crown during the clinical try-in.

Fig. 6: After the self-adhesive incorporation of the finished crown, the overall appearance was harmonious.
Fig. 6: After the self-adhesive incorporation of the finished crown, the overall appearance was harmonious.

Fig. 6: After the self-adhesive incorporation of the finished crown, the overall appearance was harmonious.

Fig. 7: The crown was esthetically integrated into the remaining natural dentition.
Fig. 7: The crown was esthetically integrated into the remaining natural dentition.

Fig. 7: The crown was esthetically integrated into the remaining natural dentition.

Fig. 8: Result: The detailed view clearly illustrates the recreation of all the nuances of the natural teeth.
Fig. 8: Result: The detailed view clearly illustrates the recreation of all the nuances of the natural teeth.

Fig. 8: Result: The detailed view clearly illustrates the recreation of all the nuances of the natural teeth.

VITA Zahnfabrik 
H. Rauter GmbH & Co. KG
Spitalgasse 3
79713 Bad Säckingen

+49 (0)7761-56 20

info@vita-zahnfabrik.com

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