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Case Study: Porcelain Veneers

Hand-Layered & Pressed

Esthetic porcelain veneers can be used in a variety of situations. Take a look at this unique case New Image Dental Laboratory fabricated in partnership with Dr. Kenneth Murphy of Atlanta. The case is fully documented below.

This complex restorative case combined Empress Esthetic veneers and IPS e.max crowns.  The centrals were a challenging combination of a Zirconia abutment and e.max crown for #8 along with an e.max crown on #9. The implant crown is very slightly out of occlusion for functional purposes. Empress Esthetic veneers on teeth # 5, 6, 7, 10 , 11, and 12 completed the total maxillary transformation.

BEFORE                               AFTER

Presurgical/Diagnostic: The patient presented with a history of childhood trauma for teeth #8 and 9. Tooth #9 had a previous crown restoration. Tooth #8 failed due to external resorption.

Treatment Objectives: The patient was interested in correcting his midline discrepancy and improving anterior esthetics.

Treatment Plan: Dr. Murphy advised the patient of the need to extract tooth #8 and replace with an implant/crown. He also suggested orthodontic treatment with which the patient complied.  A provisional was placed  on tooth #9 during the orthodontic treatment.

Esthetic Planning: New Image Dental Laboratory fabricated a diagnostic wax-up to finalize desired esthetics.  The patient reviewed and accepted the wax-up.

Surgical: The oral surgeon placed a Nobel Active 4.3mm at tooth #8.

Challenge: The patient had some difficulty with his provisionals as he was not very careful with his chewing and a few had to be replaced.

Outcome: The patient was very happy with his new smile. He said he will have to relearn how to smile.  From the looks of the photos, mission accomplished!

The Process Through New Image Dental Laboratory:

Diagnostic wax up:

Soft tissue model with implant analog:

Custom zirconia abutment:

Zirconia abutment on soft tissue model (Note the ideal shoulder preparations):

Finished e.max crowns #8, 9 and Empress Esthetic veneers
on # 5, 6, 7, 10, 11, 12:

The transformation:

BEFORE                                   AFTER

*Photos used with express written permission of patient in compliance with all HIPAA laws.

Contact New Image Dental Laboratory today to get started on your complex case!

Technical Tip – Diagnostic Wax-ups

A diagnostic wax-up is a mock example of the technician’s understanding of his/her treatment plan. It is provided to replicate the outcome before the patient is in the chair.

To get the most accurate diagnostic wax-up, the technician needs a full description of what is expected; items can include the following:

  • Is the goal to match existing teeth, mirror opposite side or correct teeth esthetically?
  • Will the case be veneers or crowns?
  • If the centrals are is involved, the technician needs to know the expected length of the centrals.
  • Shapes vary and any type of description of expected shape would be helpful. (ex: square, square oval, oval as found in “The Smile Styles; The Smile Guide”, or wants teeth to appear more feminine)
  • Many times Doctors will add a note that asks the technician to call for instructions. The advantage of descriptive written instructions is to expedite the completion of the diagnostic wax-up. Further, without descriptive written instructions, the technician may feel his information is complete and creates the diagnostic wax-up with the information given. Full descriptive disclosure of the expected outcome will prevent frustration on the part of both the Doctor and technician.

- Steve Bates, CDT, Specialty Ceramist

Technical Tip – Shade Taking

For best shade matching results, take the patient’s shade first, before you prep or impress. Once teeth dehydrate, it can take 6 hours or longer to rehydrate causing teeth to appear several shades lighter.

- Taffy Crofts, CDT, Ceramist