Dr. Miloš Ljubičić
DMD
• Dr. Miloš Ljubičić is a doctor of dental medicine based in Belgrade, Serbia.
• Specialised in aesthetic and digital dentistry and CAD/CAM systems.
• Creator of the international course of standards and protocols in dental photography “The Bigger Picture”.
• Nominated for the most promising young member of the European Society of Cosmetic Dentistry, ESCD St. Petersburg 2019.
• Lecturer of the American Society of Cosmetic Dentistry, European Society of Cosmetic Dentistry. He held lectures in the USA, UK, as well as in numerous countries in the region.
• Key opinion leader for Sprintray, Medit and GC.
introduction
introduction
Digital dentistry has transformed restorative and esthetic treatments. Technologies such as intraoral scanning, digital smile design, and chairside manufacturing enable clinicians to deliver precise, minimally invasive, and efficient care. Notably, 3D printing allows the same-day fabrication of indirect restorations with excellent esthetic and mechanical properties.
This clinical case report presents a comprehensive overview of replacing old composite veneers using a fully digital workflow and chairside 3D printing. The treatment was completed in a single visit, emphasizing minimally invasive principles, patient-centred planning, and adhesive dentistry protocols.
Patient Presentation
Patient Presentation
A female patient presented with dissatisfaction concerning her existing composite veneers in the anterior region. The restorations exhibited fractures, wear, and discoloration over time, adversely impacting her smile and self-confidence. (Fig. 1–7)
The patient requested a more natural, durable, and esthetically pleasing solution, preferably without significant tooth reduction.
During the initial consultation, the patient emphasized the importance of preserving her natural tooth structure and completing the treatment in as few visits as possible due to professional commitments.
Clinical Examination and Diagnosis
Clinical Examination and Diagnosis
A comprehensive diagnostic assessment was conducted, including the following:
- Intraoral and extraoral photographic documentation
- Clinical examination of hard and soft tissues
- Periodontal evaluation
- Occlusal analysis
- Assessment of existing restorations
The existing composite veneers exhibited marginal discoloration, surface roughness, fractures, and inadequate anatomical form. No secondary caries or pulpal pathology was detected. Periodontal tissues were healthy, with normal probing depths and no signs of inflammation.
Occlusal analysis confirmed stable intercuspation and the absence of premature contacts; temporomandibular joint function was considered within normal limits, and the patient reported no history of pain or dysfunction.
Based on these findings, the case was deemed suitable for conservative adhesive veneer replacement using digital techniques.
Treatment Planning
Treatment Planning
Following the diagnostic phase, a detailed treatment plan was formulated.
The main objectives were as follows:
- Replacement of the old composite veneers
- Preservation of maximum enamel structure
- Improvement of esthetics and surface texture
- Maintenance of functional occlusion
- Completion of treatment in a single visit
Several restorative options were discussed with the patient, including conventional laboratory-fabricated ceramic veneers and chairside digital restorations. After reviewing the advantages, limitations, treatment duration, and costs, the patient opted for a chairside digital approach using 3D printing technology.
Informed consent was obtained, and expectations regarding color, shape, and final outcome were thoroughly discussed.
Tooth Preparation
Tooth Preparation
The existing composite veneers were carefully removed using fine-grit diamond burs under magnification. Special care was taken to avoid the unnecessary removal of sound enamel.
Minimal preparation was performed in accordance with enamel-preserving principles. Preparation design included the following
- Slight facial reduction (0.3–0.5 mm)
- Rounded internal line angles
- Light chamfer finish lines
The preparation was limited primarily to areas with previous restorations. The goal was to maximize enamel bonding surface, thus improving long-term adhesion and clinical longevity.
Digital Impression and Smile Design
Digital Impression and Smile Design
Following tooth preparation, the teeth were cleaned and isolated. A digital impression was acquired using an intraoral scanner, producing high-resolution, distortion-free digital models.
This process improved patient comfort and eliminated the need for conventional impression materials.
The digital files were transferred to smile design software, where virtual planning was performed. The following parameters were evaluated and optimized:
- Tooth proportions
- Incisal edge position
- Smile line
- Midline alignment
- Buccal corridor
- Gingival symmetry
- Facial harmony
A digital smile design was generated to simulate the proposed restorations (Fig. 8, 9). This virtual preview of the anticipated outcome was presented to the patient. Minor modifications were incorporated according to patient feedback, particularly regarding tooth length and contour.
This joint approach enhanced patient involvement and improved treatment predictability.
Fabrication of Veneers
Fabrication of Veneers
Six veneers were fabricated chairside using the Sprintray MIDAS 3D printing system. High-strength hybrid ceramic resin capsules (Crown HT) were selected for their favorable mechanical properties and esthetic performance (Fig. 10).
The shade A1 was chosen to achieve a bright yet natural appearance, consistent with the patient’s facial features and complexion.
Printing and Post-Processing
Printing and Post-Processing
The fabrication workflow comprised the following steps:
- Nesting and orientation of restorations in the printing software (Fig. 11)
- Automatic generation of support structures
- Printing process (less than 10 minutes)
- Washing and cleaning in isopropyl alcohol (Fig. 12–13)
- Light curing in a dedicated curing unit (Sprintray Nanocure)
- Removal of supports (Fig. 14–16)
- Finishing and polishing
Post-processing required approximately 15 minutes. The printed veneers demonstrated excellent surface quality, marginal accuracy, and internal adaptation.
Each restoration was inspected under magnification to evaluate the following:
- Marginal integrity
- Fit accuracy
- Surface texture
- Shade consistency
- Structural defects
Minor adjustments were performed where necessary.
Try-In Procedure
Try-In Procedure
A clinical try-in was conducted before cementation. The veneers were placed on the prepared teeth using glycerin‑based try-in paste to simulate final cementation (Fig. 17–19).
The following parameters were evaluated:
- Marginal adaptation
- Proximal contacts
- Color match
- Translucency
- Overall smile harmony
- Phonetics
- Patient comfort
The patient reported high satisfaction with the esthetic outcome and approved the restorations for definitive placement.
Adhesive Cementation Protocol
Adhesive Cementation Protocol
An adhesive bonding protocol was followed to ensure optimal retention and long-term stability.
Conditioning of Veneers
Conditioning of Veneers
- Internal surfaces were cleaned with isopropyl alcohol
- Silanization was performed according to manufacturer guidelines
Tooth Surface Preparation
Tooth Surface Preparation
- Prophylaxis with pumice
- Enamel etching with phosphoric acid (Fig. 20)
- Thorough rinsing and drying (Fig. 21)
- Application of bonding agent (Fig. 22)
Cementation
Cementation
A light-cured resin cement was selected for optimal color stability. Cement was applied to the veneers, which were then seated under controlled pressure. Excess cement was removed using microbrushes and dental floss.
Each veneer was polymerized using a high-intensity curing light from multiple directions to ensure complete curing.
Occlusal Adjustment and Finishing
Occlusal Adjustment and Finishing
After cementation, occlusal stability was carefully evaluated during static and dynamic movements. Minor adjustments were made to eliminate premature contacts and ensure harmonious guidance.
Final polishing was performed using diamond-impregnated rubber polishers and polishing pastes. This step enhanced surface smoothness, gloss, and plaque resistance.
“The patient reported immediate improvement in smile confidence and comfort. Functional evaluation confirmed a balanced occlusal relationship and the absence of interferences.”
Outcome and Follow-Up
Outcome and Follow-Up
The final restorations demonstrated the following:
- Excellent marginal adaptation
- Natural translucency
- Harmonious tooth proportions
- Stable occlusal contacts
- High surface gloss
The patient reported an immediate improvement in smile confidence and comfort. The functional evaluation confirmed a balanced occlusal relationship and the absence of interferences (Fig. 23–25).
Postoperative instructions included the following:
- Proper oral hygiene techniques
- Use of non-abrasive toothpaste
- Avoidance of excessive biting forces
- Regular professional check-ups
A follow-up appointment was scheduled 2 weeks later, at which the periodontal tissues were found to be healthy, and no complications were observed (Fig. 26–30).
Discussion
Discussion
This case highlights the advantages of integrating 3D printing into chairside restorative dentistry. Compared to conventional laboratory workflows, digital fabrication offers the following:
- Reduced treatment time
- Enhanced patient comfort
- Immediate feedback and adjustments
- Cost efficiency
- Improved predictability
The minimally invasive approach preserved enamel, a crucial factor for durable adhesive bonding. The use of digital smile design improved patient–clinician communication, aligning expectations and outcomes.
High-performance printable materials have demonstrated sufficient strength and esthetics for veneer applications; thus, they are an effective option for classic ceramics in selected cases.
However, proper case selection, strict adherence to bonding protocols, and regular follow-up remain essential for long‑term success.
conclusion
conclusion
This clinical case demonstrates that chairside composite veneer replacement using a fully digital workflow and 3D printing technology is a reliable and efficient treatment option. Through careful diagnosis, conservative preparation, digital planning, and precise fabrication, high-quality esthetic and functional outcomes can be achieved in a single visit.
The integration of digital dentistry and adhesive principles allows clinicians to deliver patient-centered, minimally invasive, and predictable restorations, addressing contemporary demands for efficiency and excellence in esthetic dentistry.
NOTES
(1) De Bruyn H, Raes S, Ostman PO, Cosyn J. Immediate loading in partially and completely edentulous jaws: A review of the literature with clinical guidelines. Periodontol 2000. 2014 Oct;66(1):153-87. doi: 10.1111/prd.12040. PMID: 25123767.
(2) Silva AS, Martins D, Sá J, Mendes JM. Clinical evaluation of implant survival rates in patients who underwent immediate implant loading protocols. Dent Med Probl. 2021 Jan-Mar;58(1):61-68. doi: 10.17219/dmp/130088. PMID: 33789002.
(3) Velasco-Ortega E, Cracel-Lopes JL, Matos-Garrido N, Jiménez-Guerra A, Ortiz-Garcia I, Moreno-Muñoz J, Núñez-Márquez E, Rondón-Romero JL, López-López J, Monsalve-Guil L. Immediate Functional Loading with Full-Arch Fixed Implant-Retained Rehabilitation in Periodontal Patients: Clinical Study. Int J Environ Res Public Health. 2022 Oct 13;19(20):13162. doi: 10.3390/ijerph192013162. PMID: 36293738; PMCID: PMC9602498.
(4) Alkhouri S, Smeets R, Stolzer C, Burg S, Volz KU, Gosau M, Henningsen A. Does placement of one-piece zirconia implants influence crestal bone loss? Retrospective evaluation 1 year after prosthetic loading. Int J Oral Implantol (Berl) 2023; 16 (1): 43-51.
(5) Cristache CM, Burlibasa M, Tudor I, Totu EE, Di Francesco F, Moraru L. Accuracy, Labor-Time and Patient-Reported Outcomes with Partially versus Fully Digital Workflow for Flapless Guided Dental Implants Insertion-A Randomized Clinical Trial with One-Year Follow-Up. J Clin Med. 2021 Mar 6;10(5):1102. doi: 10.3390/jcm10051102. PMID: 33800946; PMCID: PMC7961841.
(6) Rutkowski R, Smeets R, Neuhöffer L, Stolzer C, Strick K, Gosau M, Sehner S, Volz KU, Henningsen A. Success and patient satisfaction of immediately loaded zirconia implants with fixed restorations one year after loading. BMC Oral Health 2022; 22 (1): 198.
(7) Borgonovo AE, Ferrario S, Maiorana C, Vavassori V, Censi R, Re D. A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up. Int J Dent 2021; 2021: 7534607.
(8) Ghanaati S, Al-Maawi S, Conrad T, Lorenz J, Rössler R, Sader R. Biomaterial-based bone regeneration and soft tissue management of the individualized 3D-titanium mesh: An alternative concept to autologous transplantation and flap mobilization. J Craniomaxillofac Surg 2019; 47 (10): 1633-1644.
(9) Mouhyi J, Salama MA, Mangano FG, Mangano C, Margiani B, Admakin O. A novel guided surgery system with a sleeveless open frame structure: a retrospective clinical study on 38 partially edentulous patients with 1 year of follow-up. BMC Oral Health 2019; 19 (1): 253.
(10) Lorenz J, Giulini N, Hölscher W, Schwiertz A, Schwarz F, Sader R. Prospective controlled clinical study investigating long-term clinical parameters, patient satisfaction, and microbial contamination of zirconia implants. Clin Implant Dent Relat Res 2019; 21 (2): 263-271.