A clinical case by our Community member Dr Laura Mokhtari
This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.
This patient was referred by her orthodontist to close the residual spaces and harmonize her smile. She wanted a «fuller» and brighter smile.
We can observe diastemata between lateral incisors and canines, and a difference in length and proportion between the two lateral incisors. The aesthetic study of the case showed that ideal space repartition would require to widen both the central and lateral incisors, but after discussion with the patient we chose to only close the spaces with a modification of the lateral incisors and canines with direct composite and prior bleaching.
Lateral view of the residual spaces between the lateral incisors and canines.
Before and after bleaching.
Set up of the operative field. A thick rubber dam is used. As the post-orthodontic retainer prevents from using an individualized rubber dam a split dam is used for the incisors.
Try-in of the silicone key to transfer the wax up. Shapes are modified as your can see from the index, elongation of the 22, and widening of both laterals. Also, the shape of the e ridges of the canines is planned.
The surface of the teeth was prepared by sandblasting with 50μm aluminium oxide. Then etching of lateral incisors and canines was carried out with 35% orthophosphoric acid for 30 seconds.
Close up view of the palatal shells and proximal walls.
Second bur for proximal area.
Polishing of the buccal side with a differently shaped bur.
Immediate post-op result after polishing and removing the rubber dam. Immediate result is satisfying but we need to wait for teeth rehydration.
Final result at 1 month. The patient is happy with her new smile and the composite integration is satisfying.
This said, room for improvement can be found, regarding the width of teeth 12. and 22 which is too close to that of the centrals. As mentioned above, modifying the proportion of the centrals would have involved going back to orthodontics for space distribution, and the patient didn’t want a long or complex treatment.
Before and after treatment.
Before and after treatment.
Initial aesthetic analysis is key to plan a direct composite rehabilitation, following general aesthetic rules. An initial wax up is useful to respect the proportions and planned shapes when working on several teeth. Clean operative field and correct selection of composite shades are critical for a good aesthetic result, as well as polishing and finishing, which provide both immediate and long-lasting results.
- Devoto W.Clinical Procedure for producing aesthetic stratified composite resin restorations. Pract Proced Aesthete Dent 2002, 14:541-543.
- DIestchi D. Free-hand bonding in the aesthetic treatment of anterior teeth : creating the illusion. J Esthet Dent 1997;9:156-164.
- Frank AC. Comparison of the bleaching efficacy of different agents used for internal bleaching: a systematic review and meta-analysis. Journal of Endodontics, 2022.