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Prosthodontics Restorative-Conservative Dentistry/ 10 December 2025/ |

Aesthetic Rehabilitation After Orthodontic Treatment – Clinical Case by Sergatiy Dental Clinic (Kyiv, Ukraine)

Author: Maxim Sergatiy

Website: https://www.sergatiy.com/

Email: sergatiydentalclinic@gmail.com

Nationality: Ukraine

Branch: Prosthodontics, Restorative-Conservative Dentistry

Brand: Ivoclar composite, Kuraray, Komet

Material: Ceramic, composite resin

Technique: Veneers

Summary

Many patients seek aesthetic improvement after completing orthodontic treatment.
In modern clinical practice, aesthetic rehabilitation is increasingly based on minimally invasive and carefully planned restorative protocols, as applied in specialized aesthetic clinics such as Sergatiy Dental Clinic

Initial Clinical Situation

Male patient before treatment, with short hair and fair skin, smiling against a dark background.

Patient History

A 29-year-old patient presented to the clinic seeking additional improvement in the appearance of the teeth
after completing orthodontic treatment.

Clinical Findings

Clinically, the upper lateral incisors (teeth 12 and 22) were missing. Their spaces were occupied by the canines (13 and 23), and the first premolars had been moved into the canine positions. Tooth 11 already had a direct composite restoration.

Clinical Goal

The treatment plan aimed to restore harmonious function and aesthetics by:

Transforming the canines into lateral incisors
Transforming the first premolars into canines

Possible Treatment Approaches

Several clinically acceptable approaches could be used to achieve the planned result:

Freehand direct composite build-ups
Direct composite build-ups using a palatal index
Indirect ceramic veneers

There is no single universally “ideal” material or technique. The predictability and quality of the outcome
largely depend on the clinician’s experience and manual skills.

Close-up of the upper front teeth at the initial stage of treatment, with slight enamel spots and visible gums on a black background. — Initial clinical presentation of the upper anterior teeth

What Was Done in This Case

In this case, the treatment decision was to fabricate six ceramic veneers using a refractory technique.

During the first visit, a comprehensive diagnostic evaluation was performed: intraoral scanning of the teeth, as well as photo and video documentation of the face and smile. One of the main reference parameters for planning was the smile line — an imaginary curve passing along the incisal edges of the maxillary teeth.

The smile line can be classified as high, medium, or low. Our patient had a low smile line: the upper lip covers the gingival zeniths, which makes aesthetic correction more forgiving. A high smile line, where both the anterior teeth and a large portion of the gingiva are fully visible, is considered the most demanding from an aesthetic standpoint.

All diagnostic data from the first visit were transferred to the dental laboratory to fabricate a wax-up, providing a preview of the planned final result.

At the second visit, the wax-up on the printed model was duplicated using A-silicone to create a silicone key for intraoral transfer.

Compared with a lateral incisor, a canine has greater facial volume and a characteristic cusp tip.
A premolar also differs from a canine mainly in morphology. Therefore, preliminary selective grinding is required to adapt these teeth to their new roles.

Before starting this stage, the patient must be informed that selective grinding is an irreversible procedure.

Several approaches to selective grinding can be considered:

Freehand selective grinding guided by the planned design
Selective grinding using a template (either 3D-printed or fabricated in the laboratory from pattern resin)
Transfer of a preliminary “rough” mock-up, with areas requiring reduction protruding through the material

In this clinical case, freehand selective grinding was performed according to the design after administering infiltration anesthesia.

Teeth after preliminary selective grinding

Preparation and Temporary Restorations

Using a silicone index, the provisional shape of the future teeth (mock-up) was transferred onto the selectively ground teeth.

Intraoral view of the upper anterior teeth after placement of the mock-up provisional restorations. — Appearance of the teeth after mock-up placement

The depth of facial reduction and incisal edge shortening was marked through the mock-up using a Komet 868B 314 018 depth-marking bur (Komet, Germany).

Facial depth-cut grooves on the upper anterior teeth indicating preparation depth and incisal edge reduction. — Facial depth markings for preparation and incisal edge reduction

After removing the mock-up, horizontal marks colored with a pencil remained on the teeth. Shading the facial surface with a pencil increases contrast between prepared and unprepared areas and simplifies control of reduction. The grooves retain color until the planned preparation depth is reached.

Teeth after mock-up removal with pencil markings showing areas that require further reduction. — Marking of areas requiring additional selective grinding after mock-up removal

Preparation of teeth 11, 13, 14 and 21, 23, 24 was performed using Komet diamond burs 868 314 012, 8868 314 012, 868 314 016 and 8868 314 016. On tooth 11, the old composite restoration was completely removed, so the preparation margin was placed entirely within the remaining tooth tissues. Incisal edge reduction of up to 1 mm ensured a smooth transition of translucency and an optimal esthetic outcome.

The ledge formed with minimal incisal edge preparation provides a stable seating and correct positioning of the veneers during cementation.

Tooth preparation was carried out under an operating microscope. Within the enamel, sufficient space was created for the ceramic material while carefully respecting the soft tissue level.

Intraoral view of the upper anterior teeth after preparation for ceramic veneers. — Appearance of the teeth after preparation

Gingival Retraction and Impression Taking

To accurately record the preparation margins for the laboratory, a chemomechanical gingival retraction technique with retraction cords was chosen.

The first non-impregnated cord, Sure-Cord 000, was placed to obtain vertical displacement of the soft tissues.

Placement of the first retraction cord Sure-Cord 000

A second impregnated cord, Sure-Cord 0, was then placed for about 5 minutes to obtain horizontal retraction and open the sulcus. It was inserted immediately before capturing the digital impression.

Second impregnated retraction cord Sure-Cord 0 in position

For secure fixation of the provisional restorations, spot etching of the enamel was carried out, followed by application of adhesive without prior light curing.

‍Next, temporary restorations were fabricated by a direct technique using a silicone key and self-curing composite Ivoclar Telio CS C&B (Ivoclar). After removing the silicone index, excess material in the gingival area was adjusted with a flame-shaped bur, and the adhesive on teeth with temporaries was light-cured for 20 seconds.

‍

Patient’s smile with temporary restorations in place

At the third visit, the patient returned for try-in and definitive cementation of the керамічні вініри.

Six ceramic veneers fabricated for this case

The first clinical step was removal of the provisional restorations and careful polishing of the teeth to eliminate adhesive residues.

Properly adapted temporaries help maintain healthy soft tissue contours even during extended wear. A Dry Fit try-in on a dry tooth surface makes it possible to precisely check the fit of each veneer.

Dry Fit stage (veneers tried in on a dry surface)

During the second try-in, Ivoclar Try-In paste shade Warm (Ivoclar) was applied to the veneers to mimic the final warm shade of the permanent luting composite.

Once the patient and clinician were satisfied with the esthetic outcome and shade, the adhesive cementation protocol was initiated.

Adhesive Cementation

The operative field was isolated with a rubber dam to maintain a dry working environment, which is essential for predictable adhesive cementation.

**Subsequently, the ceramic restorations were prepared for bonding:**

The internal surfaces of the veneers were cleaned with Ivoclean (Ivoclar) to remove contamination after intraoral try-in.

The veneers on the refractory die were dynamically etched with 4.5% hydrofluoric acid for 60 seconds.

96% ethyl alcohol was applied to the ceramic surface for 30 seconds to eliminate hydrofluoric acid residues.

Silane coupling agent Monobond Plus (Ivoclar) was used to silanize the ceramic and create a chemical bond with the luting composite.

ClearFil SE Bond 2 (Kuraray) was applied to the silanized ceramic surface, left for 20 seconds, and then air-thinned to remove the solvent. Variolink Esthetic LC luting composite in shade Warm (Ivoclar) was placed on the veneers, which were then stored in an orange light-protective box to prevent premature polymerization.

Adjacent teeth were protected with Teflon tape.

After isolation, the enamel was air-abraded with 27 μm aluminum oxide powder.

The micro-roughness obtained with 27 μm aluminum oxide increases the effective bonding area for the adhesive. Dynamic etching of the enamel was carried out for 30 seconds, followed by tooth conditioning with the ClearFil SE Bond 2 (Kuraray) adhesive system.

Veneers were initially light-cured on the teeth for 3 seconds (tack-curing). Excess luting composite on the facial surface was removed with a brush, and excess cement in the proximal contacts was checked and cleared with dental floss.

To minimize discoloration along the tooth–ceramic interface, the formation of an oxygen-inhibited layer was prevented using Air-Block.

Residual adhesive and cement were carefully removed with a scalpel.

Veneer cementation stage on teeth 11 and 21

‍

Appearance after veneer cementation on teeth 11 and 21

‍

Final appearance after cementation of six veneers

‍

Patient’s smile after veneer placement

Results

‍

Comparison of teeth before and after treatment

Comparison of the patient’s smile before and after treatment

Conclusion

We achieved predictable rehabilitation in the esthetically critical anterior zone. Congenital absence (agenesis) of the maxillary lateral incisors is a relatively common clinical finding.

Every case requires careful, individualized treatment planning. One option is to create space for implant placement in the lateral incisor area with subsequent prosthetic restoration. An alternative approach is to reshape the canines to resemble lateral incisors and modify the first premolars to function as canines.

There is no single “ideal” technique; the quality and longevity of the result always depend on the clinical skills of the dentist and the craftsmanship of the dental technician.

Intraoral view of teeth with the first retraction cord Sure-Cord 000 placed in the sulcus. — Appearance of the teeth after preparation

Gingival Retraction and Impression Taking

To accurately record the preparation margins for the laboratory, a chemomechanical gingival retraction technique with retraction cords was chosen.

The first non-impregnated cord, Sure-Cord 000, was placed to obtain vertical displacement of the soft tissues.

Placement of the first retraction cord Sure-Cord 000

A second impregnated cord, Sure-Cord 0, was then placed for about 5 minutes to obtain horizontal retraction and open the sulcus. It was inserted immediately before capturing the digital impression.

Second impregnated retraction cord Sure-Cord 0 in position

For secure fixation of the provisional restorations, spot etching of the enamel was carried out, followed by application of adhesive without prior light curing.

‍Next, temporary restorations were fabricated by a direct technique using a silicone key and self-curing composite Ivoclar Telio CS C&B (Ivoclar). After removing the silicone index, excess material in the gingival area was adjusted with a flame-shaped bur, and the adhesive on teeth with temporaries was light-cured for 20 seconds.

‍

Patient’s smile with temporary restorations in place

At the third visit, the patient returned for try-in and definitive cementation of the керамічні вініри.

Six ceramic veneers fabricated for this case

The first clinical step was removal of the provisional restorations and careful polishing of the teeth to eliminate adhesive residues.

Properly adapted temporaries help maintain healthy soft tissue contours even during extended wear. A Dry Fit try-in on a dry tooth surface makes it possible to precisely check the fit of each veneer.

Dry Fit stage (veneers tried in on a dry surface)

During the second try-in, Ivoclar Try-In paste shade Warm (Ivoclar) was applied to the veneers to mimic the final warm shade of the permanent luting composite.

Once the patient and clinician were satisfied with the esthetic outcome and shade, the adhesive cementation protocol was initiated.

Adhesive Cementation

The operative field was isolated with a rubber dam to maintain a dry working environment, which is essential for predictable adhesive cementation.

**Subsequently, the ceramic restorations were prepared for bonding:**

The internal surfaces of the veneers were cleaned with Ivoclean (Ivoclar) to remove contamination after intraoral try-in.

The veneers on the refractory die were dynamically etched with 4.5% hydrofluoric acid for 60 seconds.

96% ethyl alcohol was applied to the ceramic surface for 30 seconds to eliminate hydrofluoric acid residues.

Silane coupling agent Monobond Plus (Ivoclar) was used to silanize the ceramic and create a chemical bond with the luting composite.

ClearFil SE Bond 2 (Kuraray) was applied to the silanized ceramic surface, left for 20 seconds, and then air-thinned to remove the solvent. Variolink Esthetic LC luting composite in shade Warm (Ivoclar) was placed on the veneers, which were then stored in an orange light-protective box to prevent premature polymerization.

Adjacent teeth were protected with Teflon tape.

After isolation, the enamel was air-abraded with 27 μm aluminum oxide powder.

The micro-roughness obtained with 27 μm aluminum oxide increases the effective bonding area for the adhesive. Dynamic etching of the enamel was carried out for 30 seconds, followed by tooth conditioning with the ClearFil SE Bond 2 (Kuraray) adhesive system.

Veneers were initially light-cured on the teeth for 3 seconds (tack-curing). Excess luting composite on the facial surface was removed with a brush, and excess cement in the proximal contacts was checked and cleared with dental floss.

To minimize discoloration along the tooth–ceramic interface, the formation of an oxygen-inhibited layer was prevented using Air-Block.

Residual adhesive and cement were carefully removed with a scalpel.

Veneer cementation stage on teeth 11 and 21

‍

Appearance after veneer cementation on teeth 11 and 21

‍

Final appearance after cementation of six veneers

‍

Patient’s smile after veneer placement

Results

‍

Comparison of teeth before and after treatment

Comparison of the patient’s smile before and after treatment

Conclusion

We achieved predictable rehabilitation in the esthetically critical anterior zone. Congenital absence (agenesis) of the maxillary lateral incisors is a relatively common clinical finding.

Every case requires careful, individualized treatment planning. One option is to create space for implant placement in the lateral incisor area with subsequent prosthetic restoration. An alternative approach is to reshape the canines to resemble lateral incisors and modify the first premolars to function as canines.

There is no single “ideal” technique; the quality and longevity of the result always depend on the clinical skills of the dentist and the craftsmanship of the dental technician.

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Gingival Retraction and Impression Taking

Adhesive Cementation

Results

Conclusion