Dental Asia March/April 2022

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CLINICAL FEATURE Minimally-invasive restoration of an incisal edge defect with CAD/CAM hybrid ceramic With the CAD/CAM hybrid ceramic VITA ENAMIC, dentists can provide a minimally-invasive restoration for patients, while also delivering a seamless integration into the natural tooth structure. By Dr Sheng Fang and dental technician Feng Li The computer-aided design (CAD) and computer-aided manufacturing (CAM) hybrid ceramic VITA ENAMIC consists of a porous, pre-sintered, fine structure feldspar ceramic that is infiltrated with polymer. The dual ceramic-polymer network allows for very delicate reconstruction with wafer-thin, precise marginal areas of up to 0.2mm. With its dentin-like elasticity, its enamel-like abrasion behaviour and its natural light transmission, the CAD/ CAM material exhibits functional and aesthetic integration into the natural tooth structure. In the following case study, dentist Dr Sheng Fang and dental technician Feng Li demonstrate the restoration of an incisal edge defect with a minimally-invasively process on the central maxillary anterior tooth using the hybrid ceramic VITA ENAMIC. THE PATIENT’S PROFILE A 21-year-old patient presented a fracture with the composite filling of her distal corner of tooth 21 from secondary caries. She wanted a long-term, permanent restoration to be integrated harmoniously into her tooth structure. As this restoration was scheduled to be minimally invasive and required a reconstruction with Fig. 1 Fig. 1: The initial situation with fractured tooth 21 when the patient first presented at the dental practice 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 shade-matching the material blank. 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. Tooth shade 1M2 was then selected. Since 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 34 DENTAL ASIA MARCH / APRIL 2022
CLINICAL FEATURE Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 2: Secondary caries had formed under a direct composite filling, which led to a filling fracture Fig. 3: The tooth shade was systematically determined in two steps using the VITA Linearguide 3D-MASTER Fig. 4: The caries was removed under local anaesthesia and the edge areas in the enamel were slightly tapered Fig. 5: The CAD/CAM-supported finished restoration made of VITA ENAMIC with wafer-thin edges Fig. 6: The final result after the fully adhesive integration of VITA ENAMIC using composite cement 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 An intraoral scan with the CEREC Omnicam 4.2 and the virtual design of the restoration using the CAD software inLab CAD 15.2 was then carried out. The order was sent to the inLab MC XL milling unit and executed. 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 salinised. 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 transition 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, thanks to its natural play of colour 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, it was possible to treat the patient in one session. The dental team and the patient were completely satisfied with the results of the final restoration. DA This article was published with VITA’s approval. ABOUT THE AUTHORS Dr Sheng Fang Feng Li Dental technician DENTAL ASIA MARCH / APRIL 2022 35
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Dental Asia March/April 2022

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