Dental technology instructor Vanik Kaufmann-Jinoian
Dens emboliformis, also known as a peg-shaped tooth, occurs almost exclusively in the wisdom tooth or lateral incisal area. This anomaly is particularly unsightly in the anterior area, and many patients wish to have it corrected in order to close the tooth row. This is usually carried out by building up the area with composite or using veneers. Below I will demonstrate a patient case that was solved to perfection using the new CAD/CAM glass ceramic VITA SUPRINITY.
In this patient, regions 12 and 22 were affected (Fig. 1 and 2). The plan involved using VITA SUPRINITY non-prep veneers to provide both peg-shaped teeth with the shape of natural lateral incisors. This product from the new generation of glass ceramic materials was the material of choice for a number of reasons. On the one hand, a material with particularly high edge stability was required in order to be able to fabricate the delicate veneers with wafer-thin restoration edges, and without chipping. Conventional lithium disilicate is less suitable in this case. In comparison with conventional glass ceramic, VITA ENAMIC would be the better alternative in this respect. However, this hybrid ceramic can only be characterized using the staining technique, and the patient attached a great deal of importance to high-end esthetics. VITA SUPRINITY offers the possibility of esthetic individualization using the matching fine structure ceramic VITA VM 11.
Fig. 1: Initial situation: peg-shaped teeth in regions 12 and 22.
Fig. 2: Initial situation with the mouth slightly open.
Restoration using non-prep veneers
The initial situation was digitized by fabricating a plaster model and scanning it using the inEos Blue extraoral scanner from Sirona (Fig. 3 and 4). Both veneers were designed with the inLab software using the biogeneric function. The models suggested by the software were modified by hand (Fig. 5 to 7). In this case, the restorations were milled from VITA SUPRINITY using an inLab MC XL machine (Fig. 8). The veneers were then fitted on the model, and placed on conventional fibrous padding and a standard firing tray before undergoing crystallization firing (Fig. 9 and 10).
Fig. 3: Plaster model of the initial situation prior to preparation.
Fig. 4: Digitization of the model.
Fig. 5: Initial suggestion by the software.
Fig. 6: Processing of the veneer models.
Fig. 7: Final models.
Fig. 8: VITA SUPRINITY blocks with milled veneers.
Fig. 9: Fitted restorations.
Fig. 10: After crystallization firing.
For individualization, the area to be reduced was first marked on the veneers using a black felt-tip pen (Fig. 11). The incisal areas were then built up using VITA VM 11; only incisal material was used (Fig. 12 to 14). Finally, glazing was carried out using VITA AKZENT Plus Glaze (Fig. 15).
Fig. 11: Marking for reduction.
Fig. 12: VITA VM 11 was developed especially for zirconia-reinforced lithium silicate.
Fig. 13: The incisal edges of the veneers …
Fig. 14: … were built up using enamel material.
Fig. 15: Finally, glazing was carried out.
The enamel surface of both peg-shaped teeth was conditioned using a sandblaster and acid etching prior to adhesive placement. Our fastidious patient is delighted with the result: the row of teeth has been closed esthetically with no evidence of the anomaly remaining, while the veneers are in perfect harmony with the other teeth (Fig. 16 to 20). Moreover, the healthy hard dental tissue in region 12 and 22 has been protected as a result of the minimally-invasive treatment with a non-prep restoration.
Fig. 16: Final result: non-prep veneers in regions 12 and 22.
Fig. 17: Final result with the mouth slightly open.
Fig. 18: Detailed view of the veneer in region 12.
Fig. 19: Detailed view of the veneer in region 22.
Fig. 20: The patient is delighted with the perfect result.
In the production of VITA SUPRINITY, glass ceramic is enriched with zirconia (approx. 10 wt%) in order to create zirconia-reinforced lithium silicate known as ZLS. It is suitable for a wide range of indications, from anterior and posterior crowns, to superstructures on implants, through to veneers, inlays and onlays.
In my experience, the material is distinguished by outstanding processing characteristics. These include high edge stability, for example, as well as easy milling and polishing. VITA SUPRINITY demonstrates superior edge stability in comparison with lithium disilicate ceramic following processing using the inLab MC XL system. This ensures precision fit final results and was also of enormous benefit in the patient case shown here. During reworking, it is important to use milling and polishing tools that are appropriate to the task such as the VITA SUPRINITY Polishing Set that has been tailored for use with ZLS. Simple milling and polishing can then be carried out to full effect, and beautiful results achieved easily within a short time.
Also convenient is the fact that no special firing trays or firing pastes, etc., are required; the material is very "forgiving". Moreover, according to the manufacturer, the material can be used with any vacuum furnace that offers slow cooling; independence of this kind is a major plus as far as I am concerned.
In terms of how it is handled, the low-melting fine-structure feldspar ceramic VITA VM 11 is equivalent to the VITA VM components with which we are familiar, and facilitates individual layering that provides for natural esthetics.
VITA SUPRINITY enables the patient case shown here to be solved to perfection. In my opinion, the greatest benefits of the new glass ceramic are the improved edge stability and simplified crystallization.
Vanik Kaufmann-Jinoian, dental technology instructor (Fig. 21)
- Trained as a dental technician in Basel, Switzerland
- Additional training in marketing and advertising in the USA
- Owner of the Cera-Tech dental laboratory in Liestal, Switzerland
- Involved with Cera-Tech in research and development of new dental products
- International speaking engagements for a number of well-known dental companies
- Vice President of the VZLM (Association of Dental Technology Instructors), Switzerland
Fig. 21: Vanik Kaufmann-Jinoian, dental technology instructor
IMPORTANT! Please make sure to specify the source where this was first published!
Source: "digital dental magazin" 04/2014, flohr new media, Germany.
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VITA Zahnfabrik H. Rauter GmbH & Co. KG
Based in Bad Säckingen, Germany, VITA Zahnfabrik H. Rauter GmbH & Co. KG has been developing, manufacturing and selling consistently high-quality innovative solutions for dental prosthetics for over 90 years. Users in over 125 countries benefit from the analog and digital product solutions manufactured by VITA for shade determination, shade communication, shade reproduction and shade verification, which are accompanied by a comprehensive range of service options. In the last 90 years, the interaction between tradition and innovation has transformed dental visions into reality, with VITA Zahnfabrik playing a fundamental role in shaping the future of dentistry.