Cover story: Case report with Ceram.x Spectra ST Effects

Figure 1a. The patient on presentation.

Figure 1b. The patient following post-treatment reconstruction of her upper arch.

Figure 2. Pretreatment showing remaining 3 incisors with existing failing restorations and moderate TSL (Tooth Surface Loss).

Figure 3. Pretreatment showing remaining 3 incisors with existing failing restorations and moderate TSL (Tooth Surface Loss).

Figure 4. The teeth were isolated with latex free rubber dam and the sulcus inverted with floss ties: the existing restorations were removed with a diamond bur in a 1:5 speed increasing electric handpiece.

Figure 5. Caries were excavated at low speed with a steel rosehead bur. Particle abrasion was carried out with 29-micron alumina at 2-3 bar to remove biofilm and aprismatic enamel.

Figure 6. The teeth were etched with 37% phosphoric acid (Total Etch protocol) for 30 seconds on enamel and 15 seconds on dentine and Prime&Bond active (Dentsply Sirona) bonding agent applied for 20 seconds and light-cured, after solvent evaporation. A PVS stent was fabricated from a diagnostic wax up and used to guide the placement of the palatal layer: Ceram.x Spectra ST Effects D3. This opaque effect shade blocks light transmission and helps to disguise the transition between tooth structure and restoration. In addition, the D3 reduces the potential for loss of value (or “greying”) of the restoration.

Figure 7. The completed D3 layer: in the hands of the author, this is finished to full incisal length, although thinned incisally to improve light transmission; the layer is approximately half the bucco-lingual thickness of the final restoration.

Figure 8. The D3 layer is overlaid on the facial with the A3.5 Universal CloudShade (Ceram.x Spectra ST): this mass is less opaque; the increased translucency adding a perception of “depth” to the restoration. This layer is at full contour, however the incisal 2-3mm is finished 0.2-0.3mm under contour to allow addition of incisal effects. The contacts are not closed at this point.

Figure 9. E1 (Ceram.x Spectra ST Effects) Enamel shade is added to the incisal 2-3mm to create an illusion of opalescence (“grey”) and to the interproximals to close the contacts.

Figure 10. Gross contour and primary anatomy was achieved using discs.

Figure 11. The rubber dam was removed and occlusion adjusted and refined with diamond burs after marking with occlusal indicator tape.

Figure 12. The restorations were then finished and polished withEnhance and Enhance Pogo disc and point Polishers (Dentsply Sirona) to a high lustre.

Figure 13. Fine vertical enamel infractions were created with a 15-scalpel blade and the restorations finally polished with Prisma Gloss polishing paste (DentsplySirona). The patient was dismissed.

Figure 14. A Chrome-Cobalt removable partial denture (not pictured) was fabricated at a later date.