Figures 1a, 1b: A 41-year-old female presented with the chief complaint of worn and unesthetic maxillary anterior teeth. She also wanted to correct the diastema between teeth #5 & #6. To get an idea of what we could achieve, as well as possible limitations, I created a Diagnostic Wax-Up with the patient’s ideal smile in mind. It’s important for us to be able to transition from the wax-up to the final as closely as possible — or, at the very least, have the patient preview what the final smile could look like. To do that, I created a putty matrix from the wax-up. I then applied some bis-acryl material and seated it on the patient as a mockup for a trial fit.

Figures 2a–2c: After the patient’s approval, I prepared the teeth directly through the bis-acryl mockup. In doing so, I was able to ensure the final restorations had the appropriate material thickness while reducing tooth structure only in the required areas.

Figures 3a, 3b: Seven years ago, when I did this case, I still did some impressions using VPS material. If I were doing it now, I would be confident in using a digital impression for better accuracy as well as the patient’s improved comfort. When the lab delivered the veneers, I conducted a final check and made adjustments as needed on the model. I was then ready to bond the veneers to the preparations.

Figures 4a, 4b: I cleaned the preparations with a prophy cup and pumice paste at a slow speed of about 2,000–3,000 rpm. I then used a total etch technique, first etching the preps with 37% phosphoric acid. Once the teeth were etched, a thin layer of GLUMA^® Desensitizer PowerGel (Kulzer; Hanau, Germany) was used as a desensitizing and antimicrobial agent. I allowed the GLUMA to soak into the teeth for at least a minute and removed any excess with a dry microbrush. I then scrubbed a layer of 3M™ Scotchbond™ Universal Plus Adhesive (3M; Maplewood, Minn.) for at least 20 seconds per tooth to ensure the resin monomers effectively infiltrated any exposed dentinal tubules and the enamel matrix.

Figures 5a, 5b: After I tried them in, we prepared the zirconia veneers for bonding. The veneers had already been air abraded with aluminum oxide at the lab. To ensure a pristine surface for bonding, I scrubbed Ivoclean (Ivoclar Vivadent; Amherst, N.Y.) for 20 seconds on the intaglio surface of each veneer to remove any salivary phosphates that may have adhered during try-in. I then used Monobond^® Plus (Ivoclar Vivadent), which is an MDP-containing primer with a special coupling agent needed to bond zirconia restorations to resin. I then seated each restoration with Kerr’s NX3 Nexus™ Third Generation (Kerr Corporation; Brea, Calif.). I prefer this cement for its handling properties. Since it’s a light-cured cement, it offers greater working time and allowed me to seat all restorations at the same time. When all the veneers were in place, I used orange wood sticks on the facial and incisal to ensure they were fully seated against the preparations. Once seated, I tack-cured along the margins to hold the veneers in place and allow for easy removal of the gelled cement.

Figures 6a, 6b: With proper planning and the Diagnostic Wax-Up, transitioning from patient acceptance to preparation and final restorations can be done seamlessly. The final BruxZir Esthetic veneers created a fuller, more youthful smile that made the patient extremely happy.

Figures 7a, 7b: After seven years, the patient’s veneers remain securely bonded. I found no discoloration or chips in the veneers. Before treatment, this patient’s teeth were subject to erosion and chipping. The BruxZir Esthetic veneers prevented further damage.

Figures 9a, 9b: Despite the strength of the BruxZir Esthetic material, I found no wear on the patient’s opposing dentition. This is consistent with Caries Risk Assessment (CRA) findings showing that the opposing arches suffer consistently lower abrasion from zirconia than other materials, like PFM.