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Bleaching has become an essential component in contemporary dentistry, offering a non-invasive solution for tooth discoloration using agents such as hydrogen peroxide (HP), carbamide peroxide (CP), and sodium perborate. Accurate color assessment is achieved through various devices and techniques, including color scales, colorimeters, spectrophotometers, and digital photography. Resin composites provide significant advantages in the anterior region, including enhanced aesthetics through custom color matching, improved tooth contour, and seamless blending with natural dentition.
This article explores an integrated approach that combines a comprehensive home bleaching regimen with precise resin composite applications, addressing patients’ aesthetic concerns and delivering notable improvements in smile appearance and function.
Fig.1
A frontal photograph captures the patient smiling, showcasing their upper and lower teeth. The patient was dissatisfied with the color of his teeth and the shape of the four upper anterior teeth.
Fig.2
A lateral photograph was taken while the patient was smiling, showing the initial situation of the case.
Fig.3
Intraoral photographs were taken from frontal and lateral views to document the plaque that needs removal and the diastema between the anterior teeth that requires filling.
Fig.4
Plaque was removed to clean the enamel, followed by home bleaching, with the patient receiving instructions on the application of the bleaching agent. Using a custom-fit tray, a 16% CP gel from White Dental Beauty (UK) was applied for 2-4 hours daily over a four-week period. The CP gel, equivalent to a drop per tooth (about half the size of a rice grain), was provided to the patient in eight gel syringes. Thanks to Novon technology, no sensitivity was reported during the bleaching process.
An OptiShade (SmileLine, Switzerland) colorimeter was used to show the color difference, revealing an increase in L value and a decrease in a and b values. The patient was pleased with the new color of his teeth. A two-week waiting period was observed before applying resin composites on the central and lateral teeth.
Fig.5
After two weeks of bleaching, the teeth were isolated with a rubber dam. The rubber dam provides multiple benefits, including creating a clean and dry working area, reducing contamination from saliva and blood, improving visibility and access, and enhancing patient comfort during the procedure.
Fig.6
B4 clamps were placed to improve the retraction of the targeted teeth. These clamps effectively hold the rubber dam in position, allowing for optimal isolation of the teeth. By securing the rubber dam and retracting surrounding tissues, the B4 clamps facilitate a more precise and controlled working environment.
Fig.7
Diastema closure between the central incisors was achieved using the Front Wing technique by Jordi Manauta. First, accurately shape the buccal wings as close to the final contour as possible, allowing for adjustments if necessary. Once the shape is perfected, place two pre-contoured matrices to ensure tight proximal contact. Next, apply a drop of flowable composite near the proximal margin, followed by filling the palatal surface with packable composite. Condense the composite until no excess flows from the buccal. After building the first palatal surface, remove its matrix before constructing the second one to ensure a perfect seal.
Fig.8
Immediately after finishing and polishing, the rubber dam was removed.
Fig.9
After one week, the patient returned for adjustments to the shape of the laterals and expressed great satisfaction with the results.
Fig.10
Final situation (lateral view).
Fig.11
Final situation (lateral view).
Fig.12
An intraoral picture of the final situation shows the harmonious integration of the teeth with the resin composite.
Fig.13
The patient was happy with the color and the shape of his teeth.
Fig.14
Lateral view of the final situation.
Fig.15
The before-and-after pictures clearly highlight the difference.
Fig.16
Before and after
Conclusions
In conclusion, home bleaching combined with resin composites offers a comprehensive approach to enhancing both the color and aesthetics of teeth. Home bleaching provides a convenient and effective way to lighten tooth shade, while resin composites allow for precise restorations and corrections. Together, these treatments can achieve a well-balanced, natural-looking smile, addressing both discoloration and structural imperfections with flexibility and aesthetic improvement.
Bibliography
- Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
- 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 Jan 29;9:e10606.
- Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
- Manauta J. The Front Wing Technique. 2017 styleitaliano.org
