Esthetic rehabilitation of a complex clinical case
A 55-year-old female would like her smile to look more beautiful. The solution: esthetic veneers in the entire maxillary area. Experience the rehabilitation of this complex case and immerse yourself in the clinical and technical workflows from start to finish.
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The patient
Name: Valerie
Age: 55 years
Country: Israel
Valerie is a 55-year old woman from Israel. She has been unhappy about her smile for as long as she can remember and this is why she would like it to be improved.
Valerie has already undergone several treatments. The last treatment was abandoned prematurely to avoid the devitalization of her teeth and the associated need for root canal treatment and even further reaching therapies.
Valerie is frustrated. All she wants is a solution that will work for her. In other words, a solution that is
- highly esthetic,
- works reliably and
- will be long-lasting.
A demanding and thrilling task for the treatment team!
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The operators

Dr Mirela Feraru
Mirela Feraru, DMD, graduated in 2005 from the Dental Faculty of the Timisoara University in Romania. In 2009, she joined the Bichacho Clinic in Tel Aviv. For the last eight years, she has gained in-depth knowledge and experience in the fields of perio-prosthetics and esthetic dentistry, focusing on restorative and perioplastic surgical treatments. She continues expanding her knowledge and participating in advanced programs and courses in various fields of modern perio-prosthetics. In addition, Dr Feraru is an expert in high quality dental photographic documentation and shares her photographic skills with colleagues in articles, lectures and workshops across the globe.
Dr Feraru has published international articles on adhesive restorations, interdisciplinary state-of-the-art concepts in perio-prosthetics and high-end treatment-dedicated dental visualization. On the latter topic, she has authored a book, published by Quintessence Publishing.

Prof. Dr Nitzan Bichacho
Nitzan Bichacho, DMD, holds the post of expert in prosthodontics at the rank of Professor, at the Faculty of Dental Medicine of the Hebrew University and Hadassah, Jerusalem, Israel.
He is a Faculty Member of the Departments of Oral Rehabilitation of both dental facilities at the Hebrew University in Jerusalem and at Tel Aviv University in Tel Aviv, Israel.
In addition, he is Past President and a Life Member of the European Academy of Esthetic Dentistry (EAED).
He serves on the editorial boards of leading dental journals. Prof. Bichacho is co-inventor of the Nobel Active System (Nobel Biocare) and the V3 Implant System (MIS/Dentsply) and other techniques and systems that have come to be widely used around the world. Prof. Bichacho is a popular international speaker in the fields of dental implant therapy, fixed prosthodontics and innovative treatment modalities in esthetic dentistry. His private practice in Tel Aviv focuses on interdisciplinary treatments, where he and his team collaborate with world-renowned dental technicians.

Dr Galit Talmor
Galit Talmor, DMD, MSc, graduated from the Dental Faculty of the Hebrew University in Jerusalem, Israel, in 2003. She is a Faculty Member of the Department of Oral Rehabilitation of both dental facilities at the Hebrew University in Jerusalem and at Tel Aviv University in Tel Aviv, Israel.
Dr Talmor joined the Bichacho Clinic in Tel Aviv in 2005, and her focus is on prosthetic treatments with esthetic orientation, mainly adhesive restorative treatments with special emphasis on direct complex restorations.
Dr Talmor lectures locally and internationally, sharing her wide experience and knowledge.
She lectures and holds practical workshops in the field of prosthetic and restorative dentistry, focusing on direct and indirect composite restorations.

Stefano Inglese
After completing his degree in Dental Technology, Stefano Inglese, MDT, pursued his strong interest in high-accuracy esthetic and functional production of dental restorations, concentrating on dental ceramics. Stefano Inglese has perfected his technique and precision in esthetics, function and biological integration due to this passion for the artistic and scientific aspects of his profession and the participation in numerous courses and work experiences with renowned master technicians and clinicians abroad.
He is the owner of a dental laboratory in Pescina, Italy.
In 2003, he won the second prize in the “Occlusal Compass” international competition for dental technicians and the first prize for the best scientific and photographic documentation. He is a member of Oral Design and is an active member of IAED (Italian Academy of Esthetic Dentistry).
Stefano Inglese writes for national and international dental publications, such as QTD (Quintessence of Dental Technology) 2012, 2014 and 2018 as well as for Quintessenz Zahntechnik. He and Dr Anthony Sclar contributed to the book “Interdisciplinary Treatment Planning II”, edited by M. Cohen. He lectures at international conferences and collaborates with internationally renowned clinicians in Italy and abroad. Stefano Inglese is the author of the book “Aesthetic Dental Strategies”, published by Quintessence Publishers in 2013 and currently available in Italian, English and Chinese with a Russian version coming soon.
Direct or indirect? The agony of choice
A variety of treatment modalities are worth considering when creating adhesively bonded restorations in the esthetic zone:
- direct composite restorations
- indirect composite restorations
- layered veneers
- all-ceramic restorations made of lithium disilicate
The decision whether a direct or indirect modality should be used depends on a number of factors:
- preserving the vitality of the teeth
- amount of healthy tooth structure available
- functional aspects
- personal preferences
- esthetic expectations
- age
- financial means
Direct restorative therapy: maximum conservation of tooth structure
Direct restorative therapies ensure maximum conservation of healthy tooth structure. This treatment modality is especially suitable for Class V, IV and III restorations and for elective minor shape and shade adjustments.
Indirect restorations: highly esthetic results
Indirect restorations provide highly esthetic final results due to the long-lasting optical characteristics and dimensional stability of the glass-ceramic materials used for these restorations. The final shape can be optimally controlled. This comes especially into play when large proportions of the teeth need replacing. Indirect procedures to provide patients with ceramic veneers are well documented and highly efficient. They enable predictable results. They can be considered the treatment of choice in cases where enough healthy tooth structure is available. Based on the classification by Magne and Belser, there are three main indications for ceramic veneers:
- teeth that do not respond to whitening procedures
- substantial morphological alterations
- extensive restorative work in adult patients
Careful planning and accurate execution of each individual treatment step are essential to attain predictable high-quality results with veneers.
Planning the treatment steps
Detailed planning is key - especially in a complex patient case like the one presented here. A structured, well-thought-out approach is instrumental in obtaining the desired result, in which every part fits together perfectly.
For “Case Valerie”, the treatment team defined these six treatment steps:
- Esthetic analysis based on the clinical assessment and static photographic documentation of the preoperative situation and on dynamic video documentation
- Replacement of the defective composite fillings in the posterior region
- Refurbishment of the buccal corridor in the premolar region with glass-ceramic restorations (right and left)
- Replacement of the defective composite fillings in the anterior region and evaluation of the remaining tooth structure
- Guided ¾ veneer and crown preparation with the aim of improving the proportions and shapes of the teeth in the esthetic zone
- Adhesive cementation
Now see how the treatment team implemented these six steps in detail.
A glimpse behind the scenes in the dental lab
Stefano Inglese covered the dental lab side in the anterior region for this case. Let us see what he has been up to.
Basic conditions: a shared philosophy and a common goal
Stefano Inglese considers the following points as essential to the esthetic, functional and biological success of dental restorations:
- expertise
- experience
- proficiency in the use of the available technologies and materials
- interaction and communication between the team members
- shared work philosophy and a common goal
The technical and clinical stages are much easier to carry out if these requirements are met. Each clinical phase should simplify the laboratory phase, and vice versa.
“Dental technicians should be aware of the clinical concepts when carrying out their work,” Stefano Inglese points out. “This enables them to create dental restorations that respect and protect the biological structures.” From dentists, he expects: “Dentists should provide dental technicians with all the information they need to facilitate and expedite the steps in the lab and achieve more accurate results.”
Harmony and mutual respect are the key elements for this Italian Master Dental Technician to achieve optimum levels of collaboration for the benefit of the patients.
The steps in the dental laboratory

Result: Joy all round
By consistently and accurately following the prescribed workflow at every stage of the treatment and by opting for veneers as the restoration modality, a predictable result that satisfied all parties was achieved.




The postoperative images show that the restorations blend in well with the patient’s existing dentition and facial features in terms of morphology, function and appearance.
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The vitality of all teeth could be preserved. The patient is absolutely delighted with the result.
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Expert advice
An appropriate and efficient communication strategy within the treatment team and a sound treatment plan helped us achieve a harmonious result in spite of our minimally invasive approach.
4th International Expert Symposium
Did you know: Prof. Bichacho and Dr Feraru will give a presentation at the 4th International Expert Symposium in Rome/Italy on 16 June 2018. The topic of their presentation is:







