Efficient layering for high-quality dental implant esthetics

Master Dental Technician Marcio Breda,
Vitória, Espírito Santo, Brazil

"Beauty lies in simplicity" – the ancient Greek philosopher Plato already knew this over 2000 years ago. Many in dental technology have had this experience: A small embellishment or too much creativity can take away the natural look of a restoration. The restoration can look less like a nature-inspired work of art that blends with the neighboring hard tooth substance to form a unit, but rather can appear artificial and superimposed. A ceramic veneering system should complement the simple process so that the dental technician's skills can be optimized when it comes to natural beauty.

In the following case history, 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.

Initial situation vs. final result

Result: With efficient layering, a highly esthetic result was achieved.

Initial situation: The stained zirconia substructure made of VITA YZ HT after sintering.

Aesthetics and security in everyday life with a fixed full denture

A 35-year-old patient was dissatisfied with the functionality and esthetics of the full dentures in his upper jaw. The patient complained of the insufficient suction effect, the denture teeth and the base of the full denture appeared lifeless and artificial.
The patient wanted a fixed restoration on implants that would give him security and age-appropriate esthetics. 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, a master model was produced and digitized. A zirconia substructure was milled from VITA YZ HT White. The highly translucent framework structure was intended to ensure natural translucency in the area of the teeth right from the start.

Sintering and washbake

After finishing, the dental parts of the framework were infiltrated with VITA YZ HT SHADE LIQUID A3 in order 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 in order to implement a natural fluorescence in the depths. Strong GINGIVA rosewood was used in the mucosal area for an initial reproduction.

The stained zirconia substructure made of VITA YZ HT after sintering.

The washbake with FLUO INTENSE sand and GINGIVA rosewood.

Dentine cores and cut-back

After the washbake, the dentine cores were layered with more chromatic DENTINE A3 on the canines and with DENTINE A2 on the other teeth, and then anatomical cut-backs were performed.

The dentine core with DENTINE A3 on the canines and DENTINE A2 on the other teeth.

Anatomical cut-backs were done after the layering of the dentine core.

Mamelon structure and enamel layering

On the incisors, the mamelon structure was reconstructed with MAMELON saffron. The first enamel layering was done in the upper two-thirds with translucent ENAMEL clear to allow the mamelon anatomy to appear three-dimensional from the depths.

The mamelon structure of the incisors was reconstructed with MAMELON saffron.

The first enamel layering was done in the upper two-thirds with ENAMEL clear.

Separation and alternating layering

After the first firing, the approximal areas were separated to eliminate tension. This was followed by alternate layering of ENAMEL clear, ENAMEL fog and OPAL TRANSLUCENT opal-neutral.

The approximal region was separated to prevent tension.

Alternating layering of the cutting edge with ENAMEL clear, fog and OPAL TRANSLUCENT opal-neutral.

Completion of cutting edge and gingiva

After the second firing, the cutting edge was completed with alternating layers of ENAMEL fog and TRANSLUCENT smoky-white. The gingiva was then reproduced with a balanced mixture of GINGIVA grapefruit and ENAMEL clear.

ENAMEL fog, TRANSLUCENT smoky-white and GINGIVA grapefruit with ENAMEL clear.

ENAMEL fog, TRANSLUCENT smoky-white in the region of the teeth and GINGIVA grapefruit with ENAMEL clear in the gingival region.

Correction firing and finishing

After the third firing, only morphological corrections were made in the dental area with PEARL shell, which achieved a mother-of-pearl effect A mixture of ENAMEL clear and GINGIVA light-rose completed the mucosal area.
After the last firing, the finishing was carried out with differently shaped, fine diamond instruments and rubber polishers. A glaze firing with VITA AKZENT PLUS GLAZE LT provided the finalization.

The correction firing was done dentally with PEARL shell and gingivally with GINGIVA light-rose.

The restoration after finishing with diamonds and rubber polishing.

High esthetics with ease

In the finished work, teeth and gingiva appear as a natural unit. After only a few layers, it was possible to achieve a highly esthetic result. This proved to be an efficient advantage, particularly in the long span restoration. The layered ceramic simplicity had created a no-frills and believable esthetic: optimum beauty in a very short time.

The finished, glazed implant prosthetic work looked absolutely natural.

Gingiva and teeth had merged into a nature-identical unit.

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