Digital smile design-driven minimally invasive lithium disilicate laminate veneers in the aesthetic zone: a 6-year follow-up case report

The foundational principle of minimally invasive dentistry is the preservation of sound tooth structure. Its efficacy is directly dependent upon strict adherence to an optimized clinical protocol and mastery of dedicated instrumentation. This case report illustrates a conservative Digital Smile Design (DSD) - guided approach to ceramic laminate veneer rehabilitation of the maxillary anterior dentition, significantly enhancing the patient's smile. A 29-year-old female presented with the chief complaint of an unattractive smile due to an imbalanced smile line, tooth form, tooth angle and color in the aesthetic zone. DSD concepts were carried out using the Photoshop software, followed by diagnostic wax-up and mock-up to reconstruct aesthetically harmonious tooth form and color. The patient approved the minimally invasive treatment with a gingivectomy using a scalpel and veneers for 10 anterior teeth instead of the orthodontic treatment. A temporary prosthesis based on a silicone index was used to aid the conservative tooth preparations and lithium disilicate (LDS) veneers were bonded under total isolation conditions with a rubber dam. The adhesive protocol employed a total-etch technique, followed by the application of a bonding agent, intermediate dentin sealing (IDS) and a light-cured adhesive resin to optimize bonding efficiency. Following proper planning and sequencing, the outcomes successfully achieved fulfilled the patient's aesthetic demands and were reevaluated as well-maintained using the Modified United States Public Health Service (USPHS) criteria at 6-years follow-up. The application of DSD followed by LDS veneer restorations allows a minimally invasive approach with an excellent long-term outcome for the disharmonious anterior teeth, especially in high-aesthetic-demand patients.