Quite frequently, when patients come to be seen with this kind of situation, the question arises of what method to use in restoring the teeth: direct or indirect. This is especially true when the tooth has been previously treated endodontically. When discussing the advantages and shortcomings of different methods with the patient, it is important to consider the materials to be used for the restoration, how much time will be needed, and the wishes of the patient. Regardless of the situation, I always start with how the patient presents, as well as the amount of surviving tissue.
Fig.1
A couple of months ago a young lady came to me for treatment. She asked me to replace her old restorations, which she had had for the last 10 years, with new ones.
Fig.2
Before setting to work I select the color for the restorations. I use small amounts of CompoSite resin, expose them to a curing light, and, together with the patient I evaluate which shades will be used.
Fig.3
A silicone key was fabricated before starting treatment as the patient was happy with the shape and length of the old restorations.
Fig.4
Not a single treatment takes place without high-quality isolation, since all the materials are sensitive to moisture. It is also very convenient for both the dentist and the patient.
Fig.5
I remove the old restorations and evaluate the tooth tissue volume.
Fig.6
Tooth 11 was previously treated endodontically.
Fig.7
Because of the severe discoloration, an opaque shade was used to cover tooth 11.
Fig.8
The palatal walls were built using the previously fabricated silicone key.
Fig.9
Occlusal view.
Fig.10
The palatal and proximal walls allow to concentrate on the layering.
Fig.11
A darker shade was layered in the cervical area, and a lighter one on the incisal. Translucent and opalescent shades were used to get a natural effect.
Fig.12
Before proceeding to contouring, the future outline is marked with an ordinary pencil. Then, a red-banded flame bur is used to create the shape of the restoration.
Fig.13
The finished restorations before rubber dam removal and polishing.
Fig.14
The final result after polishing.
Fig.15
Before and after.
Fig.16
The smile of a happy patient.
Conclusions
Modern composite resin makes it possible not only provide patients with swift, high-quality treatment, but also to maintain a high aesthetic standard. With a broad spectrum of shades and various optical characteristics, the final result appears very natural.
Bibliography
1. Devoto W1, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth.
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. , Quintessence Books, 2012.
3. Dietschi D. Optimizing smile composition and esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent 2008; 3(1):14-29.
4. Fahl Junior N, The direct/indirect composite resin veneers : a case report. Pract Periodontics Aesthet Dent 1996 ; 8 : 627-638 .
