Initial Diagnosis
A 49-year-old female patient presented to Dr Jose Clavijo at Digital Dental Surgery Sydney with concerns about generalised discolouration of the maxillary anterior teeth. She described her teeth as having a greyish appearance.
The discolouration had been present since childhood. The patient believed it may have been associated with antibiotic use during early development. She had previously attempted tooth whitening, but it had not produced any noticeable improvement.
The main clinical challenge was to mask the intrinsic grey discolouration while creating highly natural veneer restorations. Treatment also needed to preserve as much tooth structure as possible. This required careful material selection, conservative preparation, and close control of value, shade integration, and translucency.
Treatment Plan
Comprehensive pre-operative records were obtained before treatment. These included standardised clinical photographs, short video recordings, and an intraoral digital scan to document the patient’s baseline aesthetics and occlusion.
A digital wax-up was then created to plan the proposed aesthetic outcome and guide the treatment workflow. Two silicone putty indices were fabricated from the wax-up. The first acted as a reduction guide to support conservative, controlled tooth preparation. The second was used to fabricate the provisional restorations.
Following preparation, Dr Clavijo completed a definitive intraoral scan and sent it to Avant Dental Lab for fabrication of the final restorations.
After consultation with Ian Feigen, Avant Dental’s Head of Technical, a highly aesthetic zirconia veneer system was selected. The aim was to balance the masking required for the intrinsic grey discolouration with the strength, longevity, and natural appearance expected from the final restorations.
At the insertion appointment, the veneers were evaluated with try-in pastes. Dr Clavijo assessed the fit, value, shade integration, and translucency, while a translucent try-in paste simulated the final cement shade. Both the dentist and patient approved the shape, proportions, and overall appearance before bonding proceeded.
The intaglio surfaces of the zirconia veneers were air-abraded and treated with zirconia primer according to the manufacturer’s recommendations. The restorations were then adhesively bonded under isolation with RelyX™ Veneer Cement in Translucent. Excess resin cement was carefully removed, and the occlusion was assessed, including protrusive and excursive movements.
Following cementation, a postoperative digital scan was taken for fabrication of a fully programmed custom occlusal splint. At the subsequent appointment, the splint was delivered and adjusted to achieve even bilateral contacts in centric relation and smooth canine guidance during excursive movements. This provided added protection for the ceramic restorations.
The workflow included the following stages:
- Pre-operative records: Standardised photographs, videos, and an intraoral scan documented the starting aesthetics and occlusion.
- Digital planning: A digital wax-up established the proposed aesthetic outcome.
- Preparation guides: Two putty indices supported conservative preparation and provisional fabrication.
- Lab fabrication: A definitive scan was sent to Avant Dental for fabrication of the zirconia veneers.
- Try-in and bonding: Fit, value, shade integration, and translucency were assessed before adhesive bonding.
- Protection: A postoperative scan was taken for a fully programmed custom occlusal splint.
Ian Feigen, Avant Dental’s Head of Technical, spoke about the case. “The main challenges involved balancing high translucency with structural strength in ultra-thin monolithic zirconia, managing exceedingly fine minimal-prep margins to avoid ceramic flash or bulk, and achieving natural shade dynamics in ultra-thin zones. Dr Jose’s meticulous clinical prep work and close collaborative communication with us overcame these hurdles, ensuring seamless digital planning and a flawless final fit.”
Treatment Summary
This case required careful digital planning to address longstanding intrinsic discolouration while preserving tooth structure:
- The patient presented with generalised grey discolouration of the maxillary anterior teeth.
- Previous whitening had not produced any noticeable improvement.
- Clinical photographs, videos, and an intraoral scan were obtained before treatment.
- A digital wax-up and two silicone putty indices were produced.
- One index guided conservative preparation, and the other was used for provisional restorations.
- A definitive scan was sent to Avant Dental after preparation.
- Zirconia veneers were selected following consultation with the lab.
- The veneers were evaluated with try-in paste before adhesive bonding.
- A custom occlusal splint was fabricated after cementation.
A smiling dentist and thrilled patient
The final zirconia veneers achieved the functional and aesthetic objectives of the treatment. The patient was pleased with the shape, proportions, and overall appearance at try-in, and was thrilled with the natural appearance of her new smile after cementation.
Avant Dental’s technicians delivered veneers with excellent fit, natural morphology, and highly aesthetic results. Dr Clavijo reported that the restorations required minimal adjustment at the insertion appointment.
Clear, responsive communication between Dr Clavijo and the Avant Dental team helped each stage of the workflow progress smoothly. The digital wax-up, preparation guides, definitive scan, material consultation, and precise fabrication created a controlled workflow from planning through to delivery.
For a case involving difficult intrinsic discolouration and high aesthetic expectations, the result demonstrated the value of conservative preparation, digital planning, thoughtful material selection, and close dentist-lab collaboration.
According to Dr Clavijo: “The Avant Dental technicians demonstrated exceptional attention to detail in both the design and fabrication of the restorations, delivering veneers with excellent fit, natural morphology, and outstanding aesthetics that required minimal adjustment at the insertion appointment.”
See what’s possible with digital veneer planning
Want to discover how Avant Dental’s digital planning, material guidance, and laboratory support can help dentists manage complex aesthetic veneer cases? Visit or call Avant Dental at 1800 287 336 to explore what’s possible for your patients.
All case studies presented by Avant Dental are done so with permission from the ordering dentist. No patient details are shared, and all representations are true and accurate to the case.