Dental Asia January/February 2024

CLINICAL FEATURE
Efficient layering for
high-quality dental
implant aesthetics:
Case study
A natural looking and aesthetically pleasing
restoration can be achieved using simple technique
and complementary materials. Master Dental
Technician Marcio Breda describes how beauty can
be created with ease on six implants using the highly
translucent zirconia VITA YZ HT White and the
universal veneering ceramic VITA LUMEX AC.
CASE STUDY
A 35-year-old patient was dissatisfied with the
functionality and aesthetics of the full dentures
in his upper jaw. The patient complained of
the insufficient suction effect, which generally
made him feel insecure in public and was
accompanied by rocking when biting and
chewing. As a result, he avoided hard foods.
The denture teeth and the base of the full
denture also appeared lifeless and artificial.
The patient wanted a fixed restoration on
implants that would give him security and
age-appropriate aesthetics. After detailed
diagnostics and a consultation, he decided
on six implants and a superstructure made of
zirconia and veneer ceramics that could be
fitted individually and match the natural teeth
in his lower jaw. The base tooth shade A3 was
determined for the incisors in the lower jaw
using the VITA classical A1-D4 shade guide.
CLINICAL STEPS AND CAD/CAM
After the insertion and healing of the implants,
an impression with model analogues and an
opposing jaw impression provided the basis
for the production of a master model and
its articulation in the registered jaw relation.
The model situation was then digitised in the
laboratory scanner Ceramill Map 400+.
The construction was anatomically reduced,
incorporating six GM Mini Conical Abutments
with the exocad software. The zirconia
substructure was finally milled from the zirconia
VITA YZ HT White using the Ceramill Motion 2
(Fig. 1). The highly translucent framework
structure was intended to ensure natural
translucency in the area of the teeth right from
the start.
INFILTRATION AND LAYERING
After finishing, the dental parts of the framework
were infiltrated with VITA YZ HT SHADE LIQUID
A3 to match the base tooth shade of the lower
jaw teeth. A corresponding infiltration with VITA
YZ EFFECT LIQUID Pink was carried out in the
gingival area for the basic reproduction of the
gingiva. After drying, the framework was sintered.
The washbake was done in the dental area
with VITA LUMEX AC FLUO INTENSE sand to
implement a natural fluorescence in the depths.
Strong GINGIVA rosewood was used in the
mucosal area for an initial reproduction (Fig. 2).
The dentine cores were layered with more
chromatic DENTINE A3 on the canines and with
DENTINE A2 on the other teeth (Fig. 3). Next,
anatomical cut-backs were performed (Fig. 4).
On the incisors, the mamelon structure was
reconstructed with MAMELON saffron (Fig. 5).
The first enamel layering was done in the upper
two-thirds with translucent ENAMEL clear to
allow the mamelon anatomy to appear 3D from
the depths (Fig. 6).
Fig. 1: The stained zirconia substructure made of
VITA YZ HT after sintering
Fig. 2: The washbake with FLUO INTENSE sand
and GINGIVA rosewood
Fig. 3: The dentine core with DENTINE A3 on the
canines and DENTINE A2 on the other teeth
Fig. 4: Anatomical cut-backs were made after the
layering of the dentine core
Fig. 5: The mamelon structure of the incisors was
reconstructed with MAMELON saffron
Fig. 6: The first enamel layering was done in the
upper two-thirds with ENAMEL clear
DENTAL ASIA JANUARY / FEBRUARY 2024 37