VITABLOCS Mark II feldspar ceramic: for highly esthetic and precise laboratory substructures

A 60-year-old patient presented at our practice because he was unhappy with the esthetics of his upper anterior teeth. During the clinical examination, it became apparent that the teeth in this area were rotated and tilted and demonstrated significant abrasion in the incisal and palatal zone. Periodontitis was also diagnosed in combination with recessions and cervical defects. For this reason, initial treatment was comprised of periodontal therapy, which was followed by restoration of the exposed cervical areas using composite. The patient's upper anterior dentition was to be restored using crowns. VITABLOCS Mark II was chosen as the restoration material in order to meet the patient's demanding esthetic requirements. With this true-to-shade and biomimetic material as a basis, the individual appearance of the lower dentition was to be reproduced using VITA LUMEX AC veneering ceramic and the VITA AKZENT Plus stain system.

Using frontal digital photographs of the patient smiling, 2D digital smile design was carried out in the exocad software (Exocad, Darmstadt, Germany). This was followed by intraoral scanning using CEREC Primescan (Dentsply Sirona, Bensheim, Germany) that was imported using the Connect Case Center so that both datasets could be combined in Smile Creator from exocad, and a 3D digital wax-up finalized. The resulting virtual model was then fabricated with FREEPRINT model light-curing resin (DETAX, Ettlingen, Germany) using additive technology in the MiiCRAFT Ultra 150 (Hsinchu, Taiwan) printing unit. This was then used as the basis for fabricating a silicone key for a direct mock-up using PROTEMP 4 (3M, Seefeld, Germany). The mock-up was modified morphologically and checked again in a second session. 

In the same session and prior to preparation, the final mock-up was scanned as a design template and the tooth shade 1M2 determined using VITA Linearguide 3D-MASTER. Once the upper anterior dentition had been milled for full crowns, the impression was taken using CEREC Primescan in the CEREC software (version 5.2). The dataset was sent to the laboratory using the Connect Case Center portal so that the restorations could be designed in the CAD software inLab 22.0 (all from Dentsply Sirona, Bensheim, Germany) and milled from VITABLOCS Mark II using CEREC Primemill. This was followed by try-in intraorally of the roughly finished restorations. Prior to individualization, a silicone key was fabricated on the model in order to record the incisal extent of the restorations prior to cut-back using grinding stones and diamond-coated instruments. 

Individualization was performed using the leucite-reinforced glass ceramic VITA LUMEX AC, which can be used universally on all standard all-ceramic substructure materials. Thanks to the stability of the material, this veneering ceramic enables highly precise modelling, supports all the variations of natural dentition and provides for outstanding firing stability. After four firing cycles, final characterization was carried out using VITA AKZENT Plus EFFECT STAINS 01 (white) in the incisal area and EFFECT STAINS 05 (orange) in the cervical area. The final step was glazing using GLAZE LT. After clinical try-in and conditioning of the lumen using hydrofluoric acid and silane, adhesive placement was carried out using 3M Scotchbond Universal and the translucent composite cement 3M RelyX Ultimate (both from 3M, Seefeld, Germany). Seven days after placement, the highly esthetic integration of the all-ceramic crowns was visible in terms of shape and shade.