Esthetic Rehabilitation of Patient with Multiple Diastema following Orthodontic Treatment and Maxillofacial Surgery: a Case Report

Abstract

To perform esthetic rehabilitation with diastema closure of a patient after ortho-surgical treatment using lithium disilicate veneers. A 22-year-old male patient with multiple diastema in the maxillary arch following orthodontic treatment and maxillofacial surgery applied for prosthodontic treatment. Digital planning was done on preoperative photographs in 3Shape Smile Design software. The width/length ratio of the central incisors had key importance when choosing a triangle tooth form with a Proportional Smile Design. Study casts were mounted by facebow and bite records for analog wax-up (KaVo Protar evo 5B Articulator). Wax-up was guided by the contour line of smile design. A silicone block was prepared for the functional mock-up which was found esthetic and comfortable for the patient. A 0.4 mm width butt joint preparation was used for IPS e-max CAD lithium-disilicate veneers. Two phases one-time A-silicone impression was taken with double-cord technique. Veneers were delivered by superimposing the abutment teeth and the wax-up STL files in CAD software (Ceramill Mind). Restorations were manufactured from IPS e-max CAD lithium-disilicate MT A2 blocks and were individually characterized. The final restoration was cemented with LC adhesive resin cement (Variolink Esthetic LC) in rubber dam isolation. The patient was satisfied with the esthetic and functional outcome of the final restorations. Analog/digital workflow following treatment planning with 3Smile Design software makes treatment predictable. Proportional Smile Design is an effective method for designing a smile balanced with the face. High-quality CAD/CAM materials offer superior esthetics for patient satisfaction in the case of minimal invasive preparation.