Micro-layering technique for esthetic rehabilitation. A case report

The esthetic rehabilitation of the anterior maxilla can present challenges, particularly when addressing improper tooth shape, size and proportion discrepancies as well as different types of restorations. The present case report provides a comprehensive approach that integrates modern digital technology with advanced ceramic restoration design and manufacturing techniques to achieve optimal esthetic and functional results in a highly demanding clinical situation.

The male patient presented with esthetic concerns, including a diastema between the central incisors, discrepancies in tooth shapes, and overall dental disharmony. The initial clinical evaluation revealed a compromised maxillary right lateral incisor, previously restored with a full-coverage crown, and an existing implant-supported crown replacing the maxillary left lateral incisor. The treatment plan included veneer restorations of the central incisors and canines, along with full-coverage ceramic crowns for the lateral incisors.

Laminate veneer preparations involved a facial-incisal reduction with a cervical chamfer and butt joint margins. A digital impression was made using an intraoral scanner. Yttria multilayered (YML) zirconia ceramic was selected as the restorative material, with a 0.3-mm facial micro-layering. A screw-retained implant crown was fabricated for the left lateral incisor, with a gold-plated custom titanium base for esthetic enhancement. All restorations were cemented using a dual-cure resin cement system.

The rehabilitation of the anterior maxilla with YML zirconia and micro-layered porcelain allowed for a conservative preparation while meeting the patient's esthetic demands. The present case report highlights the effectiveness of modern digital workflows. Nevertheless, further long-term clinical studies are required to confirm and strengthen the evidence on the predictability of zirconia veneers in esthetic applications.