Natural aesthetic appearance with porcelain veneers (Part 2)

By Somano Luang Phaxay, director of Oral Design Phuket

The master ceramist combines technical skill and an aesthetic sensibility setting the work of a dedicated artist apart from that of the tradesman. Part 1 of this series explored the creation of bespoke ceramic veneers using traditional methods over modern CAD/CAM restorations, and Part 2 presents the artistry involved for a challenging restoration.

INTRODUCTION
The evolution of dental aesthetic technology began in 1982, marked by a significant milestone initiated by Mr Willi Geller, the founder of Oral Design in Zurich, Switzerland. Over the course of four decades, he diligently observed and collaborated with practicing dental aesthetic professionals, harnessing their insights and experience.

This extensive period of engagement enabled him to curate a diverse range of skills and materials, culminating in the development of groundbreaking technology capable of faithfully replicating the nuances of natural teeth. He also recognised that close communication and co-operation between technicians and dentists is imperative to patients’ oral health and self-image.

The process begins in his lab with an initial consultation provided to the patient. This complimentary service creates confidence and support for both the patient and dentist. However, it is the subsequent three-way collaboration that proves to be the essential ingredient in realising the patient’s dream smile.

The patient consultation

The face, with its unique contours and expressions, conveys the individual personality that shapes lasting impressions. A smile stands out as a focal point, where the alignment and appearance of one’s teeth within the frame of the mouth affects the entire shape of the face. This is the essence of that crucial first impression and it is paramount that the integration of teeth with the shape of the mouth and face precedes decisions regarding colour and enhancements.

Assessing patient cases goes beyond examination of techniques and materials. These elements are simply stages on the path to ensuring patient satisfaction. When consulting with a patient, it is important to discuss the patient’s personality, needs, hopes and expectations by actively listening to them, and engaging in dialogue. This is where we connect with our patients, addressing their oral concerns and limitations.

CASE REPORT: LITHIUM DISILICATE

The patient had visited several dental clinics prior to visiting our lab; asking the clinicians if they can provide her requirements to make her smile makeover with lots of characteristic like natural teeth, i.e. translucencies, opalescence, and cracks like the natural youthful tooth.

They could not give her the results that she desired as most of the dental labs in the area only do monolithic work. After a two-hour consultation, listening to her desires and wishes about her veneers, we were confident we would give her what she desired. I referred her to our closest dentist partner in Phuket, Dr Ketkarn Sakultap of Dental Design Phuket clinic.

A precondition for successful treatment in this challenging case was our involvement in the pre-operative planning phase as dental technicians. By leveraging on our experiences with different restorative materials during case planning, we were confident in providing the best possible service for the patient. Intensive communication between patient, dentist and master ceramist followed, in which a variety of pre-restorative treatments were discussed (Figs. 1-3).

After receiving the impressions, a diagnostic wax up was made for the new smile that we selected the shape and colours with the cooperation of the patient visiting the lab (Figs. 4 and 5).

This first stage of diagnostic approach consists of defining a preliminary restorative goal, which is mostly obtained by the addition of wax onto preliminary model (Figs. 6-9). This procedure requires a precise knowledge of the tooth anatomy but also needs creativity, sensibility and a good perception of the patient’s individual personality. It often calls for open communication between the patient and the master ceramist.

old composite veneers
Fig. 1: Initial state of old composite veneers
Willi Geller model
Fig. 6: After the Geller model and dies preparations, the final framework was waxed-up according to the space between the silicone index and in proportions of the final veneering materials
opaque dentin
Fig. 8: Treatment grinding and fitting individually on the die. A thin wash layer was done for a good connection with an opaque dentin OD37 and a fluorescence powder HT51

Thereafter, the process of mock-up was done at the clinic (Figs. 10 and 11). At this stage the patient can approve her new smile or decide to alter a small detail. From here everything must be clear between the patient’s approval and the dentist before passing the information to the lab to process the next stage. It is the most important stage for a successful result.

The layering technique
Each patient case is unique and no standard colours recipes exists for all. However, this colours reading and mapping was from the natural tooth as reference from the patient’s internal effects such as opacity, low value or high value, translucency and opalescence (Figs. 12-29).

Creation LS lithium disilicate
Fig. 26: Final with Creation LS lithium disilicate
completed veneers  high smile line
Fig. 28: Before trying on the completed veneers, the patient with a high smile line
after completed veneers relaxed smile
Fig. 29: After trying on the completed veneers, the patient with a relaxed smile

Our aim, in collaboration with our dentist partners, is to leverage our expertise, technical skills and experience to restore patients’ self-confidence and self-esteem by recreating a beautiful smile that closely resembles natural teeth. Not all dental labs are equal or deliver the same level and quality of service. While a satisfactory result can be achieved through a tradesman or mass production, in the hands of a master ceramist every detail is exquisite, and the final product, resulting in a true masterpiece.

In this regard dental restorations created in a lab are comparable to other forms of art. The results distinguish mere functional improvement from life changing aesthetics provided by a one-of-a-kind restoration created for a specific patient.

To read the full article, click here or refer to Dental Asia May/June 2024 issue.

ABOUT THE AUTHOR

Somano Luang Phaxay

Somano Luang Phaxay qualified as a dental technician in 1998 from ‘CEPAL — CENTRE ENSEIGNEMENT PROMOTION DES METIERS (Dental Technology)’ in Nancy, France, and spent a 3 month internship at the Ivoclar Vivadent International Training Center in Schaan Liechtenstein for Dentists and Technicians. Since then, Somano has undergone many courses in ceramics and collaborated with other technicians to learn new techniques.

Somano worked three master class per year from 2006-2017 with MDT Gérald Ubassy at his International Training Center in Avignon, France. In 2015 Somano also worked with Dr Cyril Gaillard to translate from French into English the 1st DSD Course by Dr Christian Coachman in Paris, France. Somano became a member of the Oral Design International Foundation in 2022 by maestro Willi Geller.

Since 2018, Somano moved to Phuket, Thailand, and opened ‘Oral Design Aesthetic & Function Dental Studio Phuket’, a member of the Oral Design International Foundation, where he focuses on aesthetic veneer and full mouth rehabilitations cases, and training master classes on ceramics for dental technicians and dentists in the region.