Selective Cut-back Protocol for Ceramic Prosthetics in the Esthetic Area

One of the main advantages of digital dentistry is the ability to use natural teeth shape libraries in 3D software with the ability to copy the same design from the mock-up stage to the final restorations to ensure predictable results. The only way for the practitioner to ensure the reproduction of the design is by milling the prosthesis. However, the esthetic outcome of a fully milled prosthesis does not always comparable to that of the manual multi-layering effect of the ceramist. The greatest disadvantage of choosing multi-layering build-up over milling is that it is nearly impossible for the human eye and hands to replicate the exact design. To overcome this dilemma, this poster will discuss a protocol combining the precision of milling and the esthetics of layering without compromising the original smile design. In the following clinical case presentation, preoperative extraoral photographs and intraoral scanning with Medit i600 IOS were obtained. A digital smile design and wax-up was carried out on Nemo Studio software and replicated in EXOCAD. The final design was 3D printed, and silicone indices were taken for the model. The design was milled utilizing a monolithic restoration. Then, selective cutback was carried out on the labial and incisal surfaces of the restorations, and multi-layering build-up was carried out utilizing the silicone indices. The results were accurate and the esthetics were satisfying. In conclusion, combining both milling and layering with the selective cut-back protocol was very successful in replicating the original digital smile design.