Utilization of Digital Design for Esthetic Anterior Ceramic Restorations

Stern, Hannah
Faculty / Advisor: Conejo, Julian
University of Pennsylvania School of Dental Medicine, Department of Preventive and Restorative Sciences


A 24 year old female patient presents to Penn Dental Medicine with the chief complaint, "I haven’t been to the dentist in a long time and I want to clean my teeth, plus, I have this ugly crown.” The patient is ASA I and the medical history noncontributory with no medications or known drug allergies. The patient presents with gingival inflammation, extrinsic staining, diastemas between all maxillary incisors, and root canal treated #8 with a crown placed 10 years prior that is unaesthetic both in anatomy and color selection. After discussing treatment options the patient decided she wanted to undergo a smile makeover including maxillary veneers and a crown remake.

After a comprehensive evaluation the patient was treatment planned for digitally designed veneers on 6, 7, 9, 10, and 11 and a re-treatment crown on #8. A smile analysis was completed evaluating the diastemas, crown shape and length, smile arc, and incise edge position. A 3D wax-up was rendered from a diagnostic scan using a CEREC scanner. Teeth #6, 7, 9-11 were prepared using veneer prep burs and reduction was checked using a putty shell made from a 3D printed model of the digital wax-up. The PFM on #8 was removed and the tooth was prepped for a ceramic crown. A second scan was taken of the prepared teeth for final design and crown/veneer fabrication. The teeth were provisionalized using A1 Integrity. Color matching was the biggest challenge of this case due to discoloration of #8. The veneers were milled from Trilux-feldspathic ceramic in shade A1 and cemented using clear Panavia V5. The Crown for #8 was fabricated in two layers. A opaque zirconia coping cemented with RelyX and a Trilux-feldspathic veneer in shade A1 which was cemented to the coping using A2 Panavia V5 to create a similar stump shade to the rest of the anteriors. The cementation was done using the APC method.