Integrating Various Ceramic Materials and Adhesive Concepts to Achieve a Functional and Esthetic Result

Various adhesive techniques and ceramic materials can be incorporated to create a biological, functional, and esthetic smile and occlusion. In this case report, a 37-year-old woman presented to a dental school clinic seeking treatment for missing teeth. She also was dissatisfied with the color of her existing teeth and desired a broader smile (buccal corridor). In addition, tooth No. 9 had external resorption and needed to be extracted and replaced. With a previous history of unsatisfactory orthodontic treatment, the patient declined orthodontics despite the benefits it could have provided. A multidisciplinary approach was taken to replace defective restorations, address missing mandibular teeth, and improve esthetics. Treatment involved at-home bleaching, implant placement, porcelain veneers, ceramic onlays, ceramic crowns, and bonded cantilever ceramic fixed dental prostheses (FDPs). Posterior occlusion would be established through the placement of ceramic onlays and crowns and posterior cantilever ceramic FDPs to restore her missing mandibular first premolars. Anterior esthetics were then enhanced by placing ceramic veneers and an implant-supported ceramic crown (No. 9). This article demonstrates the selection and use of various ceramic materials, the proper sequencing of the placement of each restoration, and appropriate adhesive application to achieve an esthetic, long-term result. It highlights the importance of proper planning for implant crowns in the esthetic zone, as the contouring of the provisional crown provides guidance to the laboratory for fabrication of the final restoration.