Article_6_4_6-Danko
AESTETHIC DENTISTRY
DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING
Case Rreports
ULTRA-THIN LITHIUM-DISILICATE VENEERS FOR ESTHETIC
REHABILITATION OF FRACTURED MAXILLARY INCISORS
– A CASE REPORT
Mariann Dankó1a* , Attila Böröczky2b , Zoltán Imre Kovács3c , Judit Borbély1d , Péter Hermann1e
1
Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
2
Independent Óvár Dental Technology Kkt., Hungary
3
Department of General Dental Preclinical Practice, Faculty of Dentistry, Semmelweis University, Budapest, Hungary
a
DMD, Resident
b
DT
c
DMD
d
DMD, PhD
e
DMD, MSc, PhD, Vice-Rector
ABSTRACT DOI: https://doi.org/10.25241/stomaeduj.2019.6(4).art.6
OPEN ACCESS This is an Open Access
article under the CC BY-NC 4.0 license.
Aim: The aim of this case report is to explain the clinical and laboratory procedures
for fabricating ultra-thin lithium-disilicate pressed veneers using a mixed analog/ Peer-Reviewed Article
digital workflow. Citation: Dankó M, Böröczky A, Kovács ZI, Borbély J,
Summary: Four ultra-thin pressed lithium-disilicate veneers were produced for Hermann P. Digital workflow for virtually designing
and pressing ultra-thin lithium-disilicate veneers for
maxillary fractured incisors with the help of virtual smile design, digital wax-up esthetic rehabilitation of fractured maxillary incisors - a
case report. Stoma Edu J. 2019;6(4):261-270
and intraoral mock-up. With initial photos from the patient, the smile design could
be performed considering the patient’s individual face form. An intraoral scan Received: November 05, 2019
Revised December 05, 2019
was taken for the digital wax-up, which was guided by the contour line of smile Accepted: December 12, 2019
Published: December 17, 2019
design on the face photo. A printed model and deep-drawing template were
manufactured for the mock-up. After a guided minimally invasive preparation and *Corresponding author:
Dr. Mariann Dankó, DMD
digital impression, the final veneers were designed as an exact copy of the mock- Department of Prosthodontics, Faculty of Dentistry,
Semmelweis University
up. Wax pattern was designed on computer and fabricated by milling machine. Szentkirályi street 47, 1088 Budapest, Hungary
Finally, lithium-disilicate veneers were pressed, individualized and cemented Tel/Fax: +36703643723
e-mail: dankomariann56@gmail.com
using an adhesive technique.
Copyright: © 2019
Key learning points: 1. digital workflow is convenient for a predictable procedure the Editorial Council for the Stomatology Edu Journal.
making ultra-thin lithium-disilicate pressed veneers. 2. the virtual smile design –
digital wax-up – intraoral mock-up scheme presents an opportunity for effective
communication with the patient and laboratory. 3. smile design software
recommends an ideal smile curve for the patient with the help of definitive
points and reference lines on the face. 4. guided preparation through mock-up
preserves the greatest amount of enamel structure, which is important with
regards to adhesive cementation. 5. when pressing lithium-disilicate veneers,
a mixed analog/digital workflow using CAD and a milled wax pattern results in
better physical properties and marginal fit than fully digitally milled veneers.
Keywords: Smile Design; Digital Impression; Lithium-Disilicate; Veneers;
Pressed Veneers; Adhesive Cementation.
1. Introduction but also the predictability and visualization of the
Working with ceramic restorations in the anterior treatment plan. The development of digital dentistry
region is still a great challenge. The number and has presented an opportunity to individually
variety of ceramic materials are increasing, offering design a smile with the help of special software
thinner wall thicknesses with better physical and using points on face photos [1–4]. This can be
optical properties and a wide range of options shown to the patient first virtually, then intraorally
when a patient needs an esthetic rehabilitation as well, with digital wax-up and intraoral mock-
of the maxillary anterior teeth and smile. On the up. The procedure also helps communication with
other hand, the patients’ expectations are growing the patient and the laboratory. A possible way of
regarding not only the esthetics of the restoration achieving the desired smile is to prepare minimally
Stomatology Edu Journal 261
DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
Figure 1. Maxillary left first incisor fractured on the surface of the enamel, the mesial incisal edge of the maxillary left second incisor restored with
composite resin.
Figure 2. Initial smile photo. Figure 3. Initial maximal intercuspation position.
restorations is also better than milled. Overall,
digital clinical and laboratory workflow is important
because of the possibility it provides to design and
show a new smile to the patient, and to achieve this
form in the final restoration. When an impression of
the prepared abutments is taken with an intraoral
scanner, full digital workflow can be used with the
advantage of time-efficiency, reduced discomfort for
Figure 4. Bleached teeth after 6 weeks.
the patient, simplified clinical procedures, and better
invasive veneers [4,5]. The indications for these communication with the laboratory and the patient,
restorations include: discolored teeth after root canal given the trueness and precision levels comparable
treatment, tetracyclin, hypoplasia, hypercalcification to conventional impressions [13].
or fluorosis; covering small composite restorations; This fully digital method to mill from a lithium-
closing small diastemas; completing fractured teeth disilicate block would be faster. Yet, despite the
or enamel chipping; altering the shape of teeth; minimally invasive case in this study, the conventional
and correcting minor orthodontic problems such as pressing technique combined with digital workflow
rotation [6]. was preferred, because of the mentioned superior
A suitable material for this application is lithium- physical properties, more accurate marginal fit
disilicate, which can be processed either by and mainly the reducible wall thickness of pressed
conventional pressing or using digital milling lithium-disilicate restorations. This case report aims
techniques. Both are indicated for manufacturing to explain the clinical and laboratory procedures
ultra-thin veneers; however, pressed lithium- for fabricating ultra-thin lithium-disilicate pressed
disilicate wall thicknesses can be reduced by an veneers using a mixed analog/digital workflow.
extra 0.1 mm. The minimum wall thickness for the
pressed variant is 0.3 mm in the gingival third and 2. Case report
0.4 mm in the mid and incisal parts, while for the 2.1. Treatment plan
milled variant it is 0.4 and 0.5 mm, respectively [7]. A 25-year-old female patient presented with a need
The Scientific Documentation by Ivoclar Vivadent for esthetic rehabilitation of her fractured incisors
[8,9] and other recent studies [10,11] showed that after a bicycle accident and improvement to the
the fracture toughness of the pressed material is appearance of her smile. The mesial incisal edge of the
higher than that of the milled solution. According maxillary left lateral incisor had been missing since
to Azar et al [12] the marginal fit of the pressed the accident and was completed with composite
262 Stoma Edu J. 2019;6(4): 261-270 www.stomaeduj.com
DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
Figure 6. Aligned pictures in smile design program.
shape, which could be optionally altered. As only
the incisors were planned to be altered without
surgical treatment, the gingival line was replaced
to the original position and the smile curve shape
was repositioned to the canine-premolar line, the
result being that the incisors, mainly the second are
shorter than they should be (Fig. 7).
The 2D outline of the teeth was designed and the
parameters (texture, color, brightness) of the smile
simulation were set. The smile simulation was
transferred to the patient’s mobile phone through an
application (my3Shape app, 3Shape, Copenhagen,
Denmark), in which she could see the before and
Figure 5. Imported photo and reference points in smile design program. after smile situation in one picture (Fig. 8). Finally,
the retracted photo with the outline of the designed
material as a temporary solution for 2 months. The teeth was exported from the software, and was used
right and left central incisors were only fractured on as a guide for a digital wax-up.
the surface of the enamel, but some discoloration
had appeared on the left central incisor (Figs. 1-3). 2.3. Digital wax-up
The treatment plan was to bleach the teeth on both For a digital wax-up, an intraoral scan was taken from
arches, then to prepare her four maxillary incisors the initial status of the maxillary and mandibular
with a minimally invasive method for ultra-thin arches and maximum intercuspation (Trios 3 POD,
lithium-disilicate pressed veneers, which she agreed 3Shape, Copenhagen, Denmark). The intraoral scans
to after being informed about the benefits and risks were sent to the laboratory software (Dental System,
of the treatment. The bleaching was performed by 3Shape, Copenhagen, Denmark), in which the scans
40% hydrogen peroxide (Opalescence Boost 40%, and the picture with the smile design were aligned
Ultradent Products, South Jordan, UT, USA) and on six pairs of points. Then the desired shape of the
blue-light whitening accelerator lamp (Beyond teeth was designed on the initial scan guided by the
Command Whitening Accelerator, Beyond European outline of the smile design, and a 3D printed model
Headquarters, Zielona Gora, Poland), which resulted was produced with this design (Figs. 9-10).
in B1 color (Fig. 4).
2.4. Mock-up, pre-preparation scan and preparation
2.2. Smile design For the 3D printed model (Bego Varseo S, Bremen,
A virtual smile design and an intraoral mock-up Germany), a template was made and a bisacryl
constitute the best way to show the patient the resin (Dental Central Crown and Bridge Material,
designed form of her teeth and the appearance of Hannover, Germany) mock-up was fabricated
a new smile. It is essential that this method should intraorally (Fig. 11). The patient was satisfied with the
give the opportunity to change and correct the shape and the new smile, and changes in phonetics
form according to the patient’s expectations before were not noticeable. The mock-up was retained
producing the final veneers. First, a full-face smile by friction and used for guided minimally invasive
photo and a retracted frontal photo were needed preparation [4,5]. Three calibration points were cut
for the smile design. After importing the photos in with round diamond burs into the incisal part for 0.4
the smile design program (Smile Design, 3Shape, mm and two calibration grooves to the vestibular
Copenhagen, Denmark), the following reference surface for 0.3 mm reduction (Fig. 12). Then an overall
points and lines were set: pupils, nasal wings, and reduction was performed with a chamfer diamond
curve of the lips. In the next step, the two photos bur. The thickness of the mock-up was 0.1 mm on
were aligned moving two pairs of points (Figs. 5-6). average, so the preparation resulted in 0.2-0.3 mm
According to the reference points, the software minimal enamel loss. The margin line was prepared
recommended an ideal gingival and smile curve first paragingivally, then by double corded sulcus
Stomatology Edu Journal 263
DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
Figure 7. Ideal smile curve shape. Figure 8. Smile simulation.
Figure 9. Digital wax-up. Figure 10. 3D printed model.
retraction (Ultrapak #00 and #000, Ultradent, South color was identified as ND2 (IPS Natural Die Material
Jordan, UT, USA) 0.5 mm subgingivally (Fig. 13). The Shade Guide, Ivoclar Vivadent, Wien, Austria)
enamel of the contact surfaces was reduced with (Fig. 16). For the 0.3 mm ultra-thin lithium-disilicate
the preparation of the buccal surface, however the veneers, a medium-translucency B1 color ingot was
remaining contact point was not separated directly. selected (IPS e.max Press MT B1, Ivoclar Vivadent,
A new workflow was started in the software and a Wien, Austria).
digital impression was made from the maxilla with
a mock-up as a pre-preparation scan. For this scan, 2.7. Laboratory procedure
a second mock-up was fabricated for the prepared The prescription was accepted in the laboratory
teeth (Fig. 14), because it imitated the desired design software. After margin line and insertion
thickness and marginal fit for the final veneers and direction determination, the design was made
resulted in a finer shape and surface so later the copy by the morph to pre-preparation function of the
of the pre-preparation scan could perform a more software, which resulted in a 0.006 mm precise
accurate design for the final veneers. The second copy of the mock-up. This way, the exact same
mock-up was also used as temporary veneers and shape that the patient accepted intraorally could
retained by flow composite resin without etching be transferred to the final design on the prepared
and bonding. teeth (Fig. 17). As we chose to produce the final
restoration from pressed lithium-disilicate, the wax
2.5. Digital impression pattern for the pressing technique was performed
A digital impression was taken from the prepared by milling out the final design of the restoration
teeth by sulcus retraction then from the mandibular from a wax block (APWhite Lemon Wax Blank,
arch and maximum intercuspation. The prescription Aesthetic-Press, Düsseldorf, Germany with Zenotec
was sent to the laboratory. Mini, Wieland Dental, Pforzheim, Germany). The
wax pattern was sprued, invested (IPS PressVEST
2.6. Shade measurement and material selection Premium, Ivoclar Vivadent, Wien, Austria) and
Before preparation, the right central incisor was fired out (Denkal 4B, Calory Hi-tech Technical Ltd.,
selected as a reference tooth for shade selection. Budapest, Hungary), then pressed from the lithium
A reference photo was taken with a B1 tab chosen disilicate block (Programat EP 3000, Ivoclar Vivadent,
as best match (VITA Classical shade guide, VITA Wien, Austria). After checking the fit of the veneers
Zahnfabrik, Bad Säckingen, Germany). The actual intraorally (Fig.18), staining and glazing was made
tooth shade was a bit darker than B1; the lightness in the laboratory with the patient’s attendance (IPS
level could be described with the A1 tab but with Ivocolor Essence and Shade, Glaze Powder FLUO
the yellow hue of a B tab (Fig. 15). After preparation, and Mixing Liquid Longlife, Ivoclar Vivadent, Wien,
a die shade measurement was also performed; the Austria). During staining, the veneers were tried in
264 Stoma Edu J. 2019;6(4): 261-270 www.stomaeduj.com
DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
Figure 11. Template and bisacryl resin. Figure 12. Calibration points and grooves.
Figure 13. Prepared teeth with minimally-invasive method, sulcus Figure 14. Intraoral mock-up after preparation.
retraction.
Figure 15. Shade measurement before preparation. Figure 16. Die shade measurement.
silanated in one step with a primer (Monobond Etch
& Prime, Ivoclar Vivadent, Wien, Austria).
A sulcus retraction cord and rubber dam isolation
were applied, and the teeth were prepared with
the two-step total etch technique (Ultra-Etch,
Ultradent Products, Cologne, Germany and 3M
Adper Single Bond Plus Adhesive, 3M ESPE,
St. Paul, MN, USA). A light-curing resin cement in the
same neutral color as the try-in paste was applied
for the veneers and placed in the right position
(Variolink Esthetic LC Neutral, Ivoclar Vivadent, Wien,
Austria). The veneers were spot-polymerized for 2
seconds for easy excess cement removal, then fully
Figure 17. Virtual design of the final restoration.
polymerized for 60 seconds on each surface [5]. The
veneers were cemented one by one (Figs. 20-21).
After cementation, the occlusal contact points were
with try-in paste in neutral color (Variolink Esthetic checked in maximal intercuspation position, by
Try-In Paste Neutral, Ivoclar Vivadent, Wien, Austria) protrusion (Figs. 22-24).
(Fig. 19).
3. Discussion
2.8. Cementation Similar case reports for smile design and ultra-thin
The cementation protocol was used according to veneers were published in the last few years [1,4,5].
Ivoclar Vivadent’s Cementation Navigation System Digital smile design was performed by designing
[14]. The surfaces of the veneers were etched and the shape of the teeth and the gingival line in
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DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
Figure 18. Pressed lithium-disilicate veneers before staining and Figure 19. Final restorations on 3D printed model.
glazing.
Figure 20. Cementation in absolute isolation.
harmony with the form of the face using definite fully anatomical form. A dentin cut-back shape was
points and reference lines to approve the esthetics designed, milled from wax, pressed, and the incisal
of the patient’s smile. The impression was taken part was layered, which could lead to a difference
using the conventional method [1,4,5]. Hu et al [1] between the mock-up and the final shape [1].
used the scanned mock-up form as a “ghost image” Stanley et al [2] described a fully digital workflow
to guide the design of the final shape, albeit not to a for a full-mouth rehabilitation, in which digital smile
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DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
Figure 21. Cemented final restorations.
a b
Figure 22. Maximal intercuspation position (a) and protrusion (b).
Figure 23. Incisal margin from palatal view. Figure 24. Anterior-guidance.
design and digital impression was performed, and these veneers are extremely challenging and usually
the digital model of the wax-up was 3D printed. end-up in bulky, unsupported margins with a risk of
The mock-up was performed with vacuum formed chipping [15].
matrix and bysacril; then, after a guided preparation, Transferring the exact shape of the mock-up to
the definitive veneers were designed computer- the final restoration is essential. One benefit of the
aided and milled from e.max CAD [2]. However, mock-up is that the patient can visualize the new
in this case report it is not mentioned how the smile and can accept the shape, but if the copy of
shape of the mock-up was transformed for the the shape is not exact to a hundred percent, it could
final restoration. The wax-up – mock-up technique result in conflicts with the patient after inserting the
for patient motivation and guided preparation is final restoration [5]. Another advantage why a mock-
now a well-known, long used method [5]. The aim up should be prepared is the guided nature of the
of a mock-up driven preparation is to save as much preparation, which means that a uniform, minimally
hard tissue as possible. The preparation starts from invasive preparation and veneer wall-thickness can
the desired form with calibration grooves on the be achieved. If the design of the veneers is altered
vestibular surface; then, with a chamfer bur, the relative to the mock-up, a discrepancy from the
vestibular surface is prepared uniformly in the depth desired wall-thickness and color may occur [4]. The
of the calibration grooves. Using this method, the method described in a case report by Kovács [16] is a
tooth structure is only removed from where it is possible method to copy the exact same shape of the
needed for the final restoration [5]. Non-prep veneers mock-up to the final veneers. A pre-preparation scan
are also considered as a possibility for minimally is to be taken from the mock- up in the same workflow
invasive treatment; however, according to Magne et with the preparation scan from the abutments, after
al [15], the laboratory process and the handling of which the “morph to pre-preparation” function in
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DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
Figure 25. Final result.
the laboratory software results in a precise copy [16]. and PMMA patterns. All inlay patterns were pressed
The material choice in this case report was based from e.max Press lithium-disilicate. It was concluded
on published in vitro studies, in which the fracture that the accuracy of the marginal fit depends on the
resistance and marginal fit accuracy of IPS e.max impression technique but is independent from the
Press and CAD were examined [8–12,17]. The length material of the pattern; however, the internal fit of
of the silicate crystals in e.max Press is 3-6 µm [8] and the restorations depends on the pattern’s material.
in e.max CAD they are 0.1-1 µm [10]. The proportion Overall, the most accurate method was when a wax
of the crystal phase in Press is 70% [8]; however, in pattern was milled after digital impression [18].
CAD in the blue phase it is 40%, which will transform However, it must be considered that another option
after sintering into 70% [9]. It is suggested that to produce patterns with the CAD/CAM technique
crystallization is more complete in the pressed is 3D printing. Elfar et al. and Kang et al. compared
material than in sintered CAD blocks [10]. Because of pressed restorations from free-hand, milled and 3D
the differences in the crystal structure, the fracture printed wax patterns, but concluded with different
toughness, flexural strength and fracture load results. According to Elfar et al [19], crowns from 3D
parameters of e.max Press are greater than those of printed wax patterns were the most accurate [19];
CAD [8,9]. Furthermore, according to Schestatsly et however, Kang et al [20] reported that veneers from
al [10], the milling procedure initiates a cascade of milled wax patterns had the best marginal fit [20]. It
cracks in the material, which results in chipping [10]. has to be mentioned that they produced different
These statements correlate with Alkadi et al [11], who types of restorations and different methods to
describe that the fracture toughness of CAD blocks evaluate the results.
is lower because of a smaller crystal length and Although it is still not conclusive whether the 3D
phase, and the fractures formed in the glossy matrix printing or the milling technique is more accurate, it
where the crystal transformation was not complete. is described in the two studies that both CAD/CAM
Regarding the marginal fit of lithium disilicate techniques are more accurate than free-handed
crowns, those made with the press technique after approaches, and the marginal fits of all techniques
making a wax pattern by hand had a significantly are in the clinically acceptable range [19,20]. The
better accuracy of fit than crowns milled from a CAD cementation of lithium-disilicate pressed veneers
block [12]. The reason is suggested to be an easier was performed with an adhesive technique in
adaptation of the wax pattern to the dies than to the absolute rubber dam isolation using light curing
milled ceramic. According to a critical review, most resin cement. There are two methods mentioned for
of the studies comparing the pressed and milled surface treatment of the veneers. The Cementation
restorations concluded that the marginal fit of e.max Navigation System by Ivoclar Vivadent describes
Press is more accurate than e.max CAD [17]. The a one-component primer called Monobond Etch
pattern for the pressing technique can be produced and Prime for preparing the surface [14]; however,
by several methods depending on the impression the Scientific Documentation of IPS e.max Press [8]
technique and material of the pattern. According offers another option: first, 5% hydrofluoric gel (IPS
to Homsy et al [18], for conventional impressions, Ceramic Etching Gel), then a silanizing agent called
lithium-disilicate crowns pressed from milled wax Monobond Plus is to be applied to the surface.
patterns have a more precise marginal fit than those In an in vitro study, pressed lithium-disilicate crowns
from free-hand wax patterns. In their in vitro study, were produced and cemented with resin cement to
six combinations of techniques were compared epoxy resin-reinforced glass fiber dies with the two
with the following parameters: for conventional different surface treatments mentioned above. The
impression and gypsum cast making, wax and results showed that crowns treated with Monobond
resin patterns by hand; for conventional impression Etch & Prime had greater mechanical structural
but digitalized stone dies, milling wax and PMMA reliability and higher survival rate than those treated
patterns; and for digital impressions, milling wax with Monobond Plus [10].
268 Stoma Edu J. 2019;6(4): 261-270 www.stomaeduj.com
DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports
4. Conclusion considering conventional laboratory procedures
In cases when restorations are prepared in the such as pressing lithium-disilicate produces a better
esthetic region, the communication between outcome (Fig. 25).
the patient and the dentist is always the first key
to success. The patient has to understand the Author Contributions
opportunities and limitations, while the dentist has MD: performed clinical procedure, wrote initial
to get to know the expectations of the patient. An manuscript, AB: performed laboratory procedure
ideal situation to communicate is when the form of and final result photos, ZK: conception and design
the restorations can be visualized in the mouth by of the study, JB: revised the article critically for
performing a mock-up. important intellectual content, PH: approved the
Digital devices and software offer an effective way final version to be submitted.
for precise, time efficient, predictable, comfortable,
and individually designed rehabilitation of the Acknowledgments
patient’s smile; however, in spite of the potential The authors thank for Dental-Trade Kft., Budapest,
offered by fully digital workflows, in some cases, Hungary for producing 3D printed models.
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Stomatology Edu Journal 269
DIGITAL WORKFLOW FOR VIRTUALLY DESIGNING AND PRESSING ULTRA-THIN LITHIUM-DISILICATE VENEERS
FOR ESTHETIC REHABILITATION OF FRACTURED MAXILLARY INCISORS – A CASE REPORT
Case Rreports Mariann DANKÓ
DMD, Clinical Doctor, Resident
Department of Prosthodontics
Faculty of Dentistry
Semmelweis University
Budapest, Hungary
CV
Dr. Mariann Dankó, DMD, graduated from Faculty of Dentistry, Semmelweis University, Budapest, Hungary in
2018. She is currently attending the residency program in Prosthodontics at the Department of Prosthodontics,
Faculty of Dentistry, Semmelweis University, Budapest, Hungary. She participates in the Digital Dentistry, and
Implant Prosthetics Working Groups. She works with digital appliances and performs digital workflows also in
private practice.
Questions
1. What is/are the advantage(s) of a fully digital workflow?
qa. Time-efficiency;
qb. Simplified clinical procedures;
qc. Less discomfort for the patient;
qd. All of them
2. Which type of pattern was used to press lithium-disilicate veneers in this study?
qa. Milled wax pattern;
qb. 3D printed wax pattern;
qc. Hand-crafted wax pattern;
qd. Hand-crafted resin pattern.
3. Why is it considered to get back to a conventional pressing method while performing a
digital workflow?
qa. Pressed lithium-disilicate has more accurate marginal fit;
qb. Milled lithium-disilicate has better physical properties;
qc. Pressing lithium-disilicate is a faster procedure than milling;
qd. All of them.
4. Why is it important to perform an intraoral mock-up for the initial status?
qa. Facilitates the communication with the patient and laboratory;
qb. Possible to adjust according to patient’s expectation;
qc. Offers a guided minimally invasive preparation option for preserving hard tissue;
qd. All of them.
21 st
World Congress
on Dental
Traumatology
Lisbon, Portugal
17-20th June
2020
www.wcdt2020.com
270 Stoma Edu J. 2019;6(4): 261-270 www.stomaeduj.com