Assessing anterior composite veneer following bleaching via mobile dental photography

A clinical case written by Maroun Ghaleb and Rim Bourgi

In dental practice, aesthetics has recently become just as significant as function, structure, and biology because to the media’s emphasis on the impact of attractive appearances in everyday circumstances and current advertising. This fact affects the aesthetic needs of patients and the priority of dental therapy. The effects of one tooth that doesn’t match the color of the other teeth can be more obvious, especially in social network when people are judged on how they look. Tooth whitening has sparked innovation and given rise to new products and ideas. Further, whitening the natural dentition using vital teeth bleaching, including at-home and in-office bleaching, has become a popular, safe, and minimally invasive technique. Specifically, at-home bleaching provides stable and better whitening efficacy than in-office bleaching. Thus, it is considered the most recommended treatment for vital teeth. This procedure consists of hydrogen peroxide (HP) or carbamide peroxide (CP) gel applications. In this article, a 16% CP bleaching product was used prior to resin composite restorative work. Next, the unsatisfactory restorations were replaced with resin composite according to dental substrate. Although composite veneers may be the greatest artistic and creative expression of clinicians, direct resin procedures can be challenging to master. For the dentist who respects the art and science of cosmetic dentistry, mastering anterior direct composite restorations is a requirement. The least invasive and most conservative method for restoring color, form, and function of tooth structure is composite bonding procedure according to the aesthetic zone.

The key to success a multidisciplinary approach is to know when and how to use the right tool and product between your hand. In addition, you don’t need to have the most advanced camera or lens to do dental photography; all you need are a few methods and tips, imagination, and skillful light manipulation. Specifically, Mobile Dental Photography (MDP) concept relies on capturing photographs by using a smartphone with auxiliary lighting (Smile Lite MDP). The aim of this article is to assess a clinical case of anterior composite veneer following home bleaching procedure via MDP.

style italiano styleitaliano white dental beauty Bleaching gel used

Fig.1
Home bleaching gel was used in this case prior to restorative work. The CP bleaching product was inserted in the amount of a drop per tooth (the size of half rice grain). All the products used in this slide were taken with the help of the Smile Lite MDP1 and 2 (Smile Line, Switzerland).

style italiano styleitaliano white dental beauty teeth whitening gels
style italiano styleitaliano white dental beauty teeth whitening gels
style italiano styleitaliano Pre-operative photograph

Fig.2
Following 14 days of at-home dental bleaching by means of 16% CP (White Dental Beauty, UK), a 25-year-old-female visited the dental office asking for an aesthetic solution.
A pre-operative picture is crucial before the smile makeover to better frame the field of work. The S22 Ultra smartphone and the Smile Lite MDP2 (Smile Line, Switzerland) were used to take this photo. Six LEDs on each side of the lateral lights were turned ON and eight LEDs on the central light were turned OFF and covered with the white diffuser, thus emphasizing the surface texture of the smile.

style italiano styleitaliano Initial intra-oral situation

Fig.3
This young female was presented with improper old composite on the tooth 11 and difference in color, shape, and proportion between 11 and 21. Accordingly, 2 direct composite veneers were decided for the treatment planning since both centrals were in slight palato-version.

style italiano styleitaliano Polarized picture and shade selection

Fig.4
The picture was taken by means of a polarizing filter: The central LEDs was turned at full power ON (lateral LEDs OFF) with a polarizing effect above the central part of the Smile Lite MDP2 (Smile Line, Switzerland). Accordingly, the resulting picture might be useful for determining the color and the brightness of the teeth with details.
Try-in of the selected composite shades (Si1 and Si0.5) on the central incisor before dehydration and right after anesthesia.
In this case, Si1 shade was selected.

style italiano styleitaliano Teeth preparation, rubber dam and matrix placement, and bonding procedure

Fig.5
Removal of the old restoration on the vestibular side for the tooth 11. Further, sandblasting of tooth 11 and tooth 21 was achieved to remove the aprismatic enamel, and to enhance the adhesion to this substrate. The whole buccal surface of the tooth will be covered with composite, so it is easier to create a nice transition.
Next, rubber dam was placed to prevent accidental swallowing of restorative instruments or tooth fragments, and protecting soft tissues from sharp instruments. It is mandatory to chose the rubber dam isolation to reduce the failure rate of the restoration. Clinicians must need to practice rubber dam techniques, and never using a rubber dam would not be an acceptable approach. After that, regular Unica matrix by Polydentia company was used for creating proximal walls and recreating the natural appearance of the tooth. Further, Unica matrix could also been used for gingival retraction and supporting the cervical composite layer.
For the bonding approach, a universal adhesive was used in this case in two consecutive layers. Etching was done on enamel for 20 to 30 seconds with a rubbing motion. Although etching by means of phosphoric acid cleans the enamel surface, it causes salts precipitation on the etched enamel; these salts might be eliminated more efficiently by rubbing the acid and rinsing it, thus providing an optimal interface for the bonding.
A 20 seconds application of the adhesive was crucial for enhancing the bond strength by allowing a sufficient monomers infiltration.
Solvent evaporation was done for more than 15 seconds until no visible movement of bonding agent.

style italiano styleitaliano Bonding polymerization

Fig.6
Light curing was done for 40 seconds using the Curing Pen by Eighteeth.
A third-generation light emitting diode (LED), multi-wave, multi-peak, and polywave curing light was important for clinician to deeply cure composite material.
Two composite shades from the CompoSite System by White Dental Beauty were used:
– Si1
– SiE (Si Enamel), is used to give translucency and good opalescence properties to the restoration.
Since no major modifications were needed to correct the incisal edge, the freehand technique was used to build the palatal wall with SiE.

style italiano styleitaliano View after removing the Unica matrix

Fig.7
Finishing the outer frame and the proximal walls using the Unica matrix as a tool and White Dental Beauty CompoSite System as restorative material (Si1)
In order to manage the amount of composite material used during layering, predict the ultimate shape of the restorations, and speed up the finishing and polishing process, a frame is created when building the proximal walls and cervical area with the Unica matrix.

style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano white dental beauty composite system
style italiano styleitaliano Dentin and mamelons layering

Fig.8
The layering steps were done with Si1 to create the mamelons in the incisal edge of the centrals. In this step, a tool for composite placement could be helpful to dental clinician for better layering. This tool was known as the LM Solo Anterior Instrument (LM, powered by Styleitaliano). This instrument simplifies everything, from the modeling, to the ergonomy. You can apply your composite in an easy way, adapt it to the wall needed, and finally cure it. Thus, the layering could be reproducible by any clinician.

style italiano styleitaliano Enamel composite placement

Fig.9
SiE was placed on the top, in order to give the restorations the translucency and the opalescence properties needed.

style italiano styleitaliano Shaping of the anterior restorations

Fig.10
Restorations were now ready for finishing and polishing.

style italiano styleitaliano Rubbing an articulating paper on the buccal surface

Fig.11
An articulating paper can be used on the buccal side to replicate the surface roughness of the teeth.

style italiano styleitaliano Artistic photograph

Fig.12
This view was taken to show the buccal anatomy of the restored teeth to modify. Note that this artistic view was captured with the help of the Smile Lite MDP2 (Smile Line, Switzerland).

style italiano styleitaliano Final polished situation

Fig.13
Final polishing. The patient was very satisfied and happy with her new “single appointment smile”.
Perfecting the shape and improving color of the teeth was clearly seen.

style italiano styleitaliano Finishng the surface with Lucida diashine

Fig.14
The New Lucida™ Click and the DiaShine Lucida™ Paste allow a single-step high-gloss polishing of composite restorations and was used in this case.

Conclusions

Any dental restoration must follow a specific recipe to be successful. The combination of home bleaching and direct composite veneers are one of the most promising treatment options even for the smile makeover cases in clinical applications if done by the rules. Dental clinician must take photographs using a DSLR or Smile Lite MDP2 (Smile Line, Switzerland) to simplify their daily documentation purposes. The key for dental photography is understanding the light so you can control it. Try it out, record your results, and draw lessons from them.
Following the steps and tools described in this article will lead to a predictable and long-lasting outcome.

Bibliography

  1. Hardan LS. Protocols for Mobile Dental Photography with Auxiliary Lighting. Quintessence Publishing Co; 2020.
  2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
  3. Hardan LS, Moussa C. Mobile dental photography: a simple technique for documentation and communication. Quintessence Int. 2020;51(6):510-518.
  4. Orilisi G, Tosco V, Monterubbianesi R, Notarstefano V, Özcan M, Putignano A, Orsini G. ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nano-hydroxyapatite particles. PeerJ. 2021;9:e10606.
  5. Hardan L, Bourgi R, Cuevas-Suárez CE, Lukomska-Szymanska M, Monjarás-Ávila AJ, Zarow M, Jakubowicz N, Jorquera G, Ashi T, Mancino D, Kharouf N, Haikel Y. Novel Trends in Dental Color Match Using Different Shade Selection Methods: A Systematic Review and Meta-Analysis. Materials (Basel). 2022;15(2):468.
  6. Ghaleb M, Orsini G, Putignano A, Dabbagh S, Haber G, Hardan L. The Effect of Different Bleaching Protocols, Used with and without Sodium Ascorbate, on Bond Strength between Composite and Enamel. Materials (Basel). 2020;13(12):2710.
  7. Moussa C, Hardan L, Kassis C, Bourgi R, Devoto W, Jorquera G, Panda S, Abou Fadel R, Cuevas-Suárez CE, Lukomska-Szymanska M. Accuracy of Dental Photography: Professional vs. Smartphone’s Camera. Biomed Res Int. 2021;2021:3910291.
  8. Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite shade guides and color matching. Int J Esthet Dent. 2014;9(2):164-182.
  9. Mailart MC, Sakassegawa PA, Santos KC, Torres CRG, Palo RM, Borges AB. One-year follow-up comparing at-home bleaching systems outcomes and the impact on patient’s satisfaction: Randomized clinical trial. J Esthet Restor Dent. 2021;33(8):1175-1185.
  10. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
  11. Dietschi D, Shahidi C, Krejci I. Clinical performance of direct anterior composite restorations: a systematic literature review and critical appraisal. Int J Esthet Dent. 2019;14(3):252-70.
  12. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent. 2010;5(1):102-24.
  13. Hardan L, Bourgi R, Kharouf N, Mancino D, Zarow M, Jakubowicz N, Haikel Y, Cuevas-Suárez CE. Bond strength of universal adhesives to dentin: A systematic review and meta-analysis. Polymers. 2021;13(5):814.

RELATED CASES

Espresso Posterior: A 5-year follow-up in multiple restorations

In this case multiple posterior teeth were treated in a single visit using the StyleItaliano Espresso Posterior technique alongside a single mass of P composite