Direct approach on extremely dark teeth

Shadeguides - Bleaching - Direct anteriors
4 Oct 2017

Darkening of teeth is a pretty common phenomenon among endodontically treated teeth. In this case a patient, 40 years old female, had her four incisors with severe discromy and did not want a treatment to involve tooth preparation for crowns.

The endodontic treatment was evaluated and the retreatment of only one of them was indicated.

The bleaching of all teeth was proposed, including internal bleaching of the incisors combined with direct composite veneers, including the first premolars.

An important aspect of this kind of patient is the demand for a very good bleaching result.

Fig. 1

Img.1 – Frontal smile, initial situation.

Fig. 2

Img. 2 – Close-up of the incisors and premolars.

Fig. 3

Img. 3 – View with retractors, showing occlusion.

Fig. 4

Img. 4 – Right view of the smile.

Fig. 5

Img. 5 – Left view of the smile.

Fig. 6

Img. 6 – Access to the coronal chamber. In this step we create an internal protection with a glass ionomer cement and apply sodium perborate associated with hydrogen peroxide. Following restoration of the cavity with an adhesive system and composite resin was carried out and control was scheduled after 10 days. The patient was given a home bleaching product for external bleaching.

Fig. 7

Img. 7 – Aspect after 10 days of internal bleaching results, associated to home bleaching. In this appointment, the internal bleaching agent was renewed.

Fig. 8

Img. 8 – Aspect after 20 days of internal bleaching associated to home bleaching. In this appointment, the internal bleaching agent was renewed one more time.

Fig. 9

Img. 9 – Aspect after 30 days of internal bleaching associated to home bleaching. In this appointment, the internal bleaching agent was removed and a temporary restoration was done to facilitate the elimination of residual oxygen. The home bleaching was finished too.

Fig. 10

Img. 10 – After 3 weeks the present restorations were removed. 4 fiber post were cemented on incisors before this appointment.

Fig. 11

Img. 11 – The dental reconstruction based on previous wax-up was initiated using: Renamel OW (palatal shelf), Opaquer Renamel A1-B1-LO on the dark areas covered by layers of Herculite B2 – B1 on the deep dentin. A layer of Amelogen B1 shade was applied covering all the internal dentin and the opalescent effect was created with Supreme GT.

Fig. 12

Img. 12 – The adjacent incisors were treated with the same stratification, but customized with the necessity of each one. The enamel layer was reproduced with Renamell Microfill Body B2 on cervical third and Durafill B1 and Renamel IL microfill on the the medium and incisal third.

Fig. 13

Img. 13 – Initial aspect after primary polishing and the removal of retraction cords.

Fig. 14

Img. 14 – After 10 days the polishing and anatomy were refined.

Fig. 15

Img. 15 – Aspect after 21 days.

Fig. 16

Img. 16 – Aspect of the smile after 45 days.

Fig. 17

Img. 17 – Close-up view after 45 days.

Fig. 18

Img. 18 – Close-up lateral after 45 days.

Fig. 19

Img. 19 – Before and after in a leteral view.

 

Conclusions

With this clinical case, we can see the versatility of composite resins associated with other techniques to solve even the most difficult – and less esthetic – cases.

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