Upper incisor replaced with lithium disilicate resin-bonded prosthesis and partial veneer [Incisivo superiore sostituito con ponte adesivo e faccetta parziale in disilicato di litio]

OBJECTIVES This article presents a clinical case of rehabilitation of a central upper incisor with a lithium disilicate adhesive bridge and contextual contralateral incisor modification with a partial veneer. MATERIALS AND METHODS A 60-year-old female patient is sent to the Department of Dental Prosthetics, Section of Dentistry of the University of Ferrara, after extraction of the left upper central incisor due to periodontal reasons, for prosthetic rehabilitation. The implant option had been excluded due to the excessive bone loss that would have required bone regeneration interventions, to which the patient did not intend to undergo. A solution with an adhesive bridge was therefore proposed. However, the intraoral examination revealed a greater space than the dimensions of the missing incisor: the mesio-distal space measured 10 mm, while the up-per right central incisor measured 8 mm. A diagnostic waxing was then made by increasing the size of the right incisor, so as to obtain two 9 mm wide incisors. The mock-up that followed the waxing allowed to anticipate the aesthetic result. The dental elements were then prepared: the mesio-vestibu-lar surface of the right central incisor was prepared with a chamfer to accommodate the partial veneer. The palatal surfaces of the right central incisor and the left lateral incisor were prepared with a chamfer in the thickness of the enamel to accommodate the retainers of the adhesive bridge. A polyvinylsiloxane impression was registered (Heraeus Flexitime, Hanau, Germany). Both the partial veneer and the adhesive bridge were waxed and pressed with lithium disilicate. After the try in, the adhesive cementation steps were performed: the internal surface of the lithium disilicate was etched with 5% hydrofluoric acid (IPS Ceramic gel, Ivoclar Vivadent AG, Schaan, Liechtenstein) for 20 seconds, then rinsed and washed off in pure alcohol in ultrasound for 10 minutes. Subsequently the inner surface was treated with a silane agent (Monobond Plus, Ivoclar Vivadent AG, Schaan, Liech-tenstein) for 60 seconds and dried with hot air. The teeth were isolated with the rubber dam, cleaned and treated with an universal adhesive (Adhese Universal, Ivoclar Vivadent AG, Schaan, Liechtenstein), which was dried and light cured. The cement (Vari-olink Esthetic, Ivoclar Vivadent AG, Schaan, Liechtenstein) was applied to the inner surface, the veneer was placed and the cement was light-cured. In the same way the adhesive bridge was cemented. RESULTS AND CONCLUSIONS The 3-year control showed the maintenance of both the adhesion and the aesthetic and functional integration of rehabilitation. There are two key points to the success of the presented clinical case. The first concerns aesthetic evalua-tion: the analysis revealed a too large mesio-distal space to be op-timally rehabilitated. The waxing and the consequent mock-up allowed to anticipate the final result and highlight the need to modify the adjacent incisor to obtain the ideal result. The second key aspect of the presented case is adhesive cementation. Lithium disilicate is a etchable ceramic: this allows to obtain a true adhesion to dental tissues. It is essential to scrupulously respect the recommended cementation procedures. CLINICAL SIGNIFICANCE Anticipating the final result is crucial for deciding the treatment plan. The partial veneer is an excellent solution with a view to minimum intervention. Adhesive cementation is the key to long-term success when making a lithium disilicate adhesive bridge. © 2019 EDRA SpA.