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Special Issues
July/August 2023
Volume 44, Issue 1
Peer-Reviewed

Digital Workflow, State-of-the- Art Materials Used in Esthetic and Functional Rehabilitation

Talmadge D. Wilkins IV, DMD

A 71-year-old woman presented with worn anterior dentition, several diastemas, and a dissatisfaction with the general appearance of her smile. After a comprehensive examination, bite analysis, and esthetic evaluation, the patient agreed to treatment comprising a combination of all-ceramic crowns and veneers on teeth Nos. 4 through 14 and 23 through 26, which would accommodate her functional and esthetic desires. Because of the patient's time constraints due to an upcoming event, a complete digital workflow was used to speed up the treatment. Digital photographs and intraoral scans were taken, and a digital smile design was performed in exocad software, aimed at providing optimal esthetics and establishing functional guidance to enhance long-term success. The final restorations were made from fully polymerized, lithium-disilicate GC Initial® LiSi Block (shade B1) (GC America, gc.dental/america) on a four-axis CAD/CAM milling machine. Being fully crystalized, the blocks provided the restorations smooth, accurately milled margins and natural esthetics without firing. Slight stain and glaze were applied to the restorations with GC Initial® Lustre Paste NF. The veneers were dual-cure bonded using GC's G-CEM LinkForce® (shade A2), and the crowns were dual-cure bonded using GC's G-CEM ONE™ in the posterior. With careful digital planning and execution and state-of-the-art restorative materials, the clinician accommodated the patient's needs in less than a week.

Key Takeaways

Using a combination of digital photography, intraoral scanning, and digital planning software can
accelerate the process of creating complex and esthetic dental rehabilitations.

Because GC Initial LiSi Block is fully crystalized, it gives the milled restorations smooth and accurate margins and natural-looking esthetics without the need for firing.

In cases where a digital dental workflow can hasten and enhance final outcomes, having a thorough knowledge of smile design, esthetics, and functional occlusion is paramount to achieving world-class results.


About the Author
Talmadge D. Wilkins IV, DMD
Private Practice, Aiken, South Carolina; Fellow, Academy of General Dentistry

Fig 1. Initial portrait of the patient. Digital photographs were taken using a Canon EOS 5D Mark IV camera. This photograph was used in facially generated treatment planning to determine midline, length of teeth, and esthetic tooth position.

Figure 1

Fig 2. Initial smile photograph. The worn and chipped anterior teeth were indicative of poor function. Additionally, the patient was concerned about the diastemas between several teeth.

Figure 2

Fig 3. The anterior wear, chipping, and diastemas were very apparent against the black contraster. Note, also, the unevenness on both sides of the dentition.

Figure 3

Fig 4. A trial smile, or initial mock-up, was placed over the existing teeth using a bis-acryl temporary material. A polyvinyl siloxane (PVS) putty matrix was made on a printed digital wax-up model using a 3D printer (SprintRay). This matrix was then used to complete the trial smile, which verified the esthetic requirements for the patient.

Figure 4

Fig 5. The bis-acryl trial smile teeth were prepared using a depth cut bur. This helped to ensure a uniform thickness of the final restorative material while also guiding the clinician toward a more conservative preparation without overpreparing the teeth.

Figure 5

Fig 6. Final preparations for anterior veneers and posterior crowns. Note that much of the anterior teeth were in enamel, which aids bond strength.

Figure 6

Fig 7. After the preparations were scanned using an intraoral scanner (TRIOS, 3Shape), the prepared teeth were provisionalized using the PVS putty matrix and bis-acryl material and spot-bonded with G-Premio BOND™ (GC America) using the shrink wrap method. The patient would return 5 days later for delivery of the final crowns.

Figure 7

Fig 8. Final digital design of the maxillary arch of crowns and veneers using exocad digital planning software (exocad).

Figure 8

Fig 9. GC Initial LiSi Block and milled restorations on sprues on an organizational work sheet. All restorations were milled in the B1 shade block on a wet milling machine (Z4, vhf Inc.).

Figure 9

Fig 10. Final stained and glazed GC Initial LiSi Block crowns and veneers using GC Initial Lustre Paste NF. 3D-printed models and dies (SprintRay) were used for try-in, margin verification, and finishing prior to delivery.

Figure 10

Fig 11. The patient’s final smile. Note the fuller smile with a wider buccal corridor that was now more even on both sides. Also, the incisal edges follow the lower lip line form.

Figure 11

Fig 12. Final maxillary restorations with proper line angle development and all diastemas eliminated. Restorations were delivered only 1 week prior.

Figure 12

Fig 13. Final portrait of the very happy patient. The functional and esthetic goals were achieved in less than 1 week using a completely digital workflow and contemporary materials.

Figure 13

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