Esthetic rehabilitation of an upper incisor with VITA YZ HT and VITA VM 9

In order for a single anterior crown to blend harmoniously into the oral appearance, the special features of the natural neighboring teeth must be reproduced. In the current case, tooth 11 was restored with a crown. The challenge was to replicate distinct individual characteristics of the natural dentition, such as calcifications. Chia Heng Chung, Dental Technician (Kaohsiung, Taiwan), explains how he was able to achieve a natural result using VITA VM 9 veneering ceramic (VITA Zahnfabrik, Bad Säckingen, Germany).

1. Intraoral situation

After the filling therapy of an advanced carious lesion on tooth 11, the soft pulpal tissue of a 37-year-old patient showed signs of irreversible infection. A root canal treatment was performed to prevent pain and bone resorption. The tooth had to be functionally stabilized after this invasive therapy. To enable a highly esthetic and natural restoration, a zirconia crown made of VITA YZ HT with a VITA VM 9 veneer was planned.

2. Shade determination and substructure fabrication

The tooth shade determination with the VITA Toothguide 3D-MASTER was a critical step for the successful veneering of the crown. 2M1 was determined as the base shade. A black and white photo helped to select the correct lightness and color saturation. The preparation for a full crown was carried out with a pronounced hollow shape in order to create space for the restoration. A master model was produced using an impression. A wax framework was modelled on 11 and then digitalized with a laboratory scanner. The constructed zirconia framework was milled and sintered from a VITA YZ HT^white blank (VITA Zahnfabrik, Bad Säckingen, Germany).

3. Veneering

"Even after the first firing, the basic shade and lightness of the veneered framework should correspond to the determined tooth shade. In this case, I used a combination of VITA AKZENT Plus EFFECT STAINS and VITA VM 9 BASE DENTINE," Chia Heng Chung describes as the first, important step. In his opinion, the correct lightness is 60 percent of the success. "By controlling shade intensity and hue, we can already achieve 80 percent of the natural appearance. The remaining 20 percent depends on the individual abilities of the technician," explains Chia Heng Chung.

4. Treatment result

The finished restoration is integrated harmoniously into the esthetic zone. The full ceramic crown exhibited a natural play of color and light. Thanks to the precise determination of the basic tooth shade and the perfectly matched veneer ceramic VITA VM 9, a simple and structured approach was possible. The patient was very happy with the esthetic result. For Chia Heng Chung, CAD/CAM and craftsmanship complement each other: "The synergy between technology, art and beauty is the key factor for successful full ceramic crown and bridge restorations."

Report 08/16

Chia Heng Chung, Dental Technician
Kaohsiung, Taiwan

Fig. 1: Previously: Full crown dissection on tooth 11 after endodontic treatment.

Fig. 2: Reproduced basic tooth shade with VITA AKZENT PLUS ES06 from cervical area to upper third and BASE.

Fig. 3: Perfect conformity of VITA Toothguide 3D-MASTER and the cap shade.

Fig. 4: Cervical fluorescence (reddish/brownish) was created with EL3, a lighter incisal effect with EL1.
Fig. 5: CHROMA PLUS 2 was layered for a warm hue and control of the lightness.

Fig. 6: Complete crown layering with DENTINE 2M1 prior to the cut-back.
Fig. 7: EE1 (whitish translucent) was added in points to integrate thin, white lines.

Fig. 8: Restoration after the first firing, followed by internal staining for precise shade control.

Fig. 9: Halo effect from EE2 and BASE DENTINE. Finalization with thin layers of ENL, END and WIN.
Fig. 10: The finished full ceramic crown on the master model after glaze firing and polishing.

Fig. 11: Afterwards: The final restoration on tooth 11; the patient was pleased with the highly esthetic result.