Clinical Overview and Patient Assessment
Patient Background
A 22-year-old female patient presented to Sergatiy Dental Clinic seeking esthetic enhancement of her maxillary lateral incisors (teeth #7 and #10, ADA Universal Numbering System).
Diagnostic Findings
Upon examination following completion of comprehensive orthodontic therapy, residual spacing was identified between teeth #7–#8 and #9–#10. Both lateral incisors demonstrated relative microdontia — the teeth were within normal dimensional parameters but appeared undersized relative to the adjacent central incisors, creating an imbalanced smile proportion.
Considered Restorative Options for Space Management and Incisal Lengthening:
- Freehand direct composite bonding
- Direct composite bonding with a palatal silicone index
- Indirect composite veneer restorations
- Porcelain laminate veneers (indirect laboratory fabrication)
There is no universally superior technique or material for anterior esthetic restorations. Clinical success is closely correlated with the practitioner’s expertise, understanding of material science, and technical proficiency.
Baseline clinical presentation
Restorative Strategy and Clinical Workflow
Achieving imperceptible integration of restorations within the esthetic zone remains one of the most demanding aspects of contemporary restorative dentistry.
Step-by-Step Treatment Protocol
For this particular case, the clinical team at Sergatiy Dental Clinic elected to fabricate two ultra-thin porcelain laminate veneers utilizing the refractory die technique.
Conservative tooth preparation under high-magnification (dental operating microscope) facilitated the creation of minimally invasive restorations. The principal advantage of ultra-thin ceramic laminates is their inherent translucency, which effectively eliminates the need for a dedicated shade-matching procedure. The natural optical characteristics and chromatic properties of the underlying enamel substrate are transmitted through the ceramic shell, producing a harmonious, undetectable result in clinical function.
Appointment 1 — Data Acquisition and Digital Planning:
- Intraoral digital scan of the maxillary and mandibular arches
- Comprehensive photographic and video documentation of facial proportions, lip dynamics, and smile arc
- All diagnostic records are transmitted to the dental laboratory
- The laboratory converted the 2D aesthetic design into a three-dimensional digital treatment plan. A diagnostic wax-up was fabricated to visualize the proposed outcome and served as a critical communication tool between clinician, technician, and patient. Final tooth form and incisal length were approved by the patient at this stage.
Appointment 2 — Mock-Up Evaluation and Tooth Preparation:
- The diagnostic wax-up was duplicated from the printed model using a polyvinyl siloxane (PVS) putty matrix
- An intraoral mock-up was generated directly on the unprepared teeth using Ivoclar Telio CS C&B auto-polymerizing resin transferred via the silicone index — no enamel etching or adhesive bonding was applied — allowing the patient to preview and approve the proposed design
Upon receiving patient consent, local anesthesia was delivered by buccal infiltration. Teeth #7 and #10 were prepared using Komet diamond rotary instruments (868314012, 8868314012). Preparation design was a window-type configuration (Pascal Magne Classification — Type 1) confined entirely to enamel, without incisal overlap or incisal edge involvement. The existing labial tooth contours were deemed adequate; therefore, the preparation goal was limited to the removal of the aprismatic enamel layer and the establishment of sufficient ceramic thickness. Gingival retraction was accomplished mechanically using a braided retraction cord (Sure-Cord 000) to communicate the finish line margins to the laboratory clearly.
Gingival retraction prior to impression taking
Due to the ultra-conservative enamel-only preparation geometry and the refractory fabrication workflow, concerns regarding digital impression fidelity at this margin depth led to the selection of conventional polyvinyl siloxane impressions.
The conservative nature of the preparation, remaining entirely within enamel, eliminated any requirement for dentin desensitization protocols.
Completed tooth preparations for ceramic laminate veneers
Provisional restorations were secured using a selective spot-etch and bond technique (without light activation) to ensure reliable yet easily removable retention. Provisionals were fabricated chairside with Ivoclar Telio CS C&B auto-polymerizing resin delivered through the silicone matrix. Following matrix removal, flash resin was carefully trimmed using a #12D surgical blade. The adhesive layer was then polymerized for 20 seconds on both teeth #7 and #10.
Finished veneers on an individual refractory model replicating abutment shade
Appointment 3 — Veneer Try-In and Definitive Cementation:
Provisional restorations were removed and the enamel surfaces polished with Enhance finishing system to thoroughly eliminate any adhesive residue. A dry-fit try-in was completed first to assess marginal adaptation and seating accuracy. A second evaluation was performed using Ivoclar Variolink Try-In paste (Neutral shade) to simulate the anticipated final cemented appearance.
Dry-fit evaluation of ceramic laminates
After confirming complete diastema closure, harmonious tooth form, appropriate incisal length, shade integration, and obtaining final patient approval of the esthetic result, the adhesive cementation protocol was initiated.
Rubber dam isolation was intentionally avoided in this case. Given the 0.2 mm restoration thickness, the mechanical force required to seat a clamp or stretch the dam could potentially displace the interproximal ceramic contacts, risking fracture of these delicate restorations during the cementation procedure.
Adhesive Cementation — Ceramic and Tooth Surface Conditioning
Internal Ceramic Surface Treatment:
Contamination from the intraoral try-in was eliminated by cleansing the ceramic intaglio surfaces with Ivoclean decontamination paste (Ivoclar Vivadent):
- Dynamic acid etching of the refractory veneer intaglio with 4.5% hydrofluoric acid (HF) gel for 60 seconds to create micromechanical retention
- Application of 96% ethanol to the etched ceramic surface for 30 seconds to remove residual HF acid byproducts and precipitates
Chemical coupling was achieved by coating the etched ceramic with Monobond N silane coupling agent (Ivoclar Vivadent), establishing a reliable chemical bond between the ceramic restoration and the resin-based luting agent:
- ClearFil SE Bond 2 (Kuraray Noritake) adhesive resin applied to the silanized intaglio surface for 20 seconds; excess gently thinned with an air stream
- Variolink Esthetic LC light-cure composite cement (Neutral shade) dispensed onto the internal veneer surface
Prepared restorations were stored in a light-protective container (orange box) to prevent premature photopolymerization.
Enamel Surface Conditioning and Bonding:
Lip retraction was achieved with OptraGate (Ivoclar Vivadent); neighboring teeth were shielded with polytetrafluoroethylene (PTFE) plumber’s tape to prevent inadvertent bonding.
The following enamel conditioning sequence was performed:
- Micro-abrasion of enamel surfaces with 27-micron aluminum oxide particles to cleanse and create enhanced micromechanical surface roughness
- Dynamic phosphoric acid etching of teeth #7 and #10 enamel for 30 seconds
- Application of ClearFil SE Bond 2 (Kuraray Noritake) adhesive system to conditioned enamel
Neighboring teeth protected with PTFE tape before definitive bonding
Final Polymerization and Finishing:
Each veneer was initially tack-cured for 3 seconds to stabilize its position:
- Excess luting composite was carefully removed from labial surfaces using a micro-brush
- Interproximal cement excess was verified and cleared with unwaxed dental floss
Utilization of the soft-start (ramped) curing mode on the LED polymerization unit was essential during the final light-cure cycle to minimize polymerization stress at the adhesive interface.
To prevent marginal discoloration at the ceramic-tooth junction, the oxygen-inhibited layer was sealed using an Air Block glycerin gel prior to final cure. Any residual flash of adhesive resin and cement was meticulously trimmed with a surgical blade. Final margin refinement and polishing were accomplished via controlled air-abrasion with a Perio Kit nozzle and glycine-based prophylaxis powder (Prophyflex Perio Powder, KaVo Kerr).
Completed restoration — final clinical result
Final esthetic outcome in smile view
